Camp Happy Registration
June 5 - July 28, 2017, 9:00am-4:00pm. 7 weeks to choose from. Contact wearehappyfeat@gmail.com with questions.
PARTICIPANT INFORMATION
First Name of Camper *
Your answer
Last Name of Camper *
Your answer
Camper's Birthdate *
Your answer
Child's Age *
Your answer
Gender *
Address *
Your answer
Phone *
Your answer
Email Address (for correspondence) *
Your answer
Primary Disability *
Your answer
Secondary Disability
Your answer
Does the camper have seizures?
Your answer
List any allergies
Your answer
Additional Notes or Concerns
Your answer
Camper T-shirt Size
How does your camper communicate best?
ex: verbal, non-verbal, uses communication device, sign language, etc.
Your answer
What behavioral concerns do we need to made aware of?
ex: aggression, biting, hitting, kicking, spitting, yelling, wandering, etc
Your answer
What are your camper's known behavioral triggers?
ex: loud noises, being touched, transitions, etc
Your answer
What are your camper's current toileting needs?
ex: independent, needs verbal prompting, needs physical assistance, etc.
Your answer
What are your campers likes?
ex: types of food, activities, songs, movies, specific items, specific activities etc.
Your answer
What are your campers dislikes?
Your answer
What reinforcers do you currently use?
ex: pom poms, specific toys, time on iPad, specific activities, etc.
Your answer
What sensory needs do we need to be made aware of?
ex: loud noises, touch, crowds, etc.
Your answer
Which WEEK OF CAMP are you signing up for?
SCHEDULE
SPECIAL SCHEDULING REQUESTS
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms