Camp Happy Registration
June 5 - July 28, 2017, 9:00am-4:00pm. 7 weeks to choose from. Contact
First Name of Camper
Last Name of Camper
Email Address (for correspondence)
Does the camper have seizures?
List any allergies
Additional Notes or Concerns
Camper T-shirt Size
How does your camper communicate best?
ex: verbal, non-verbal, uses communication device, sign language, etc.
What behavioral concerns do we need to made aware of?
ex: aggression, biting, hitting, kicking, spitting, yelling, wandering, etc
What are your camper's known behavioral triggers?
ex: loud noises, being touched, transitions, etc
What are your camper's current toileting needs?
ex: independent, needs verbal prompting, needs physical assistance, etc.
What are your campers likes?
ex: types of food, activities, songs, movies, specific items, specific activities etc.
What are your campers dislikes?
What reinforcers do you currently use?
ex: pom poms, specific toys, time on iPad, specific activities, etc.
What sensory needs do we need to be made aware of?
ex: loud noises, touch, crowds, etc.
Which WEEK OF CAMP are you signing up for?
June 5 - 9
June 12 - 16
June 19 - 23
June 26 - 30
July 10 - 14
July 17 - 21
Full Week(s) ($100/week) - 9am-4:0pm
Partial Weeks (please provide specific schedule in note box below)
SPECIAL SCHEDULING REQUESTS
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