PeerBuddies Summer Camp 2025: Participant Application
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Camper's Information
Name *
(First Last)
Pronouns *
Date of Birth *
(Month/Day/Year)
Gender *
Name of Current School and Grade Level *
(If Transitioning, name of Transition school too!)
Street Address *
(Including City, State, and Zip Code)
What is the Camper's primary language?  *
Is the Camper bilingual? If yes, please list additional language(s). 
Does the Camper have any allergies? *
If "Yes", to what?
(Please List All)
What is the Peer Buddy's T-Shirt size?

Examples: Adult Medium, Youth Medium
 *
How did you hear about us? *
Parent/Guardian's Information
Parent/Guardian's Name #1
 *
(First Last)
Relationship to Camper  *
Parent/Guardian's Primary Phone Number  *
(Including Area Code)
Parent/Guardian's Email Address  *
Parent/Guardian's Name #2
(First Last)
Relationship to Camper 
Parent/Guardian's Phone Number
Parent/Guardian's Email Address
Authorized Pick-Up (in addition to parents) *
(Include Name(s), Phone Number(s), and Relationship(s)
Emergency Contact Information
Name of Emergency Contact *
(First Last)
Relationship to Camper *
(Examples: Mother, Father, Grandfather, Nanny, etc.)
Primary Phone Number *
(Including Area Code)
Summer Camp: Scheduling & Payment
Camp is from July 7th-August 1st, 2025, from 1:00-4:00pm, Monday-Friday.

The cost is $500 per week.

Which week would you like to sign up your child? *
(Multiple Weeks may be Chosen)
Required
What is your preferred payment method?

If the preferred payment method is unknown when completing this application, please select "Other" and explain. We highly encourage families to still apply even if their funding stream is not yet solidified so that their child's spot can be reserved. 
 *
Checks must be made payable to "PEERBUDDIES" and mailed to: 3463 State St. #275, Santa Barbara, CA, 93105 by June 1st, 2025.

If planning to pay by check, please write "Camp" on the memo line and type the Check Number here. 
Important Registration Information

Please note that you are signing up your child for one-week intervals. As such, payments must be made in full despite missed days. Refunds will not be given for missed days.

All cancellations must be in writing, by email to megan@peerbuddies.com.  

Cancellations received on or before May 31st, 2025 will receive a 100% refund. Cancellations received between June 1st and June 15th 2025 will receive an 80% refund. Cancellations received after June 15th are not eligible for a refund.

"I have read and understand all terms and policies listed above.  I hereby authorize PeerBuddies Camp staff to act for my child to the best of their judgement in any emergency requiring medical attention.  I hereby waive and release PeerBuddies staff from any and all liabilities for injuries or illness incurred while at camp.  I agree to direct my child to cooperate and follow directions and instructions from any PeerBuddies staff."

Please Initial to indicate you have read this and understand the terms.
 *
I understand that unforeseen circumstances may occur whereby my child's buddy is absent from a day of camp. I understand that in these circumstances, my child will be paired with a substitute "buddy" or will be temporarily placed in another dyad. *
Please Initial to indicate you have read this and understand the terms.
I understand that in the event my child must miss a day of camp, I will provide PeerBuddies with at least 24 hours' notice. *
Please Initial to indicate you have read this and understand the terms.
I allow PeerBuddies to videotape my child for the sole purpose of modifications to my child’s treatment program and continuing education of PeerBuddies facilitators. (IN-OFFICE USE ONLY) *
Please type your initials.  If you do NOT wish for your child to be videotaped, type "do not consent".
I allow PeerBuddies to use video footage of my child on the PeerBuddies website, at professional conferences/trainings, and for research purposes. (OUT OF OFFICE USE) *
Please type your initials.  If you do NOT wish for your child to be videotaped, type "do not consent".
I allow PeerBuddies to take pictures for my child’s confidential client file. *
Please type your initials.  If you do NOT wish for your child to be photographed, type "do not consent".
I allow PeerBuddies to take pictures for publication according to the terms listed above. *
Please type your initials.  If you do NOT wish for your child to be photographed, type "do not consent".
Camper's Background Information
Parents/Guardians: Please provide details regarding the camper's current behaviors
and level of support required.  This information will prepare our team to ensure the
appropriate supports are in place and that the camper's buddy is informed.  
Please indicate camper's diagnosis or reason for participation. *
(Select all that apply!)
Required
If response to previous question was "None", please describe reason for participation.
Please describe the camper's current level of verbal language. *
If response to previous question was "No Verbal Language", please indicate:
Please describe the camper's current level of reading comprehension skills.
 *
Please describe your concerns with regard to the camper's Social Skills. *
(Examples: "Difficulty initiating conversations"; "Needs help taking others' perspectives", etc.)
Please describe your concerns with regard to the camper's Behaviors. *
(Examples: "Gets frustrated quickly"; "Can be aggressive", etc.)
Please indicate "triggers" to challenging behaviors. *
(Examples: "When asked to clean up"; "When she sees a car", etc.)
What behavioral strategies have been effective for the camper?   *
(Select all that apply!)
Required
What additional information would you like us to know about the camper?
Camper Questionnaire
Camper: Please answer all of the following questions as completely as possible.
We're using this information to figure out who your Buddy will be, so the more details
you give us, the better we'll be able to match you up!  
What are your favorite things to do?  Please list your hobbies and interests. *
How would you describe your personality? *
(Please select all that apply!)
Required
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