Camp Abilities PA New Athlete Application
Camp Abilities PA @ WCU is an educational sports camp for athletes who have visual impairments that are free from secondary medical, cognitive, and/ or behavioral conditions that affect their full participation in high-intensity sports in cooperative/ team settings. Please fill out this eligibility form in order to help us and you determine if Camp Abilities is a good fit for your child.
Athlete's Full Name *
Your answer
Please check "yes" or "no" for each of the following items. *
If "no", please explain below.
No
Yes
My child will be between 7 and 17 years old at the time they will be at camp.
My child has a vision teacher and a diagnosis of blind or visually impaired.
My child is at/or within 1 year of their grade level for academics.
My child is able to independently take care of their personal hygiene and not use diapers.
My child cooperates within a group and has positive pro-social behaviors.
My child is free of disabilities that impact mobility and does not use mobility devices such as wheelchairs or crutches.
My child can sustain physical activity for several hours at a time, four days in a row.
My child is free of medical conditions that require treatment with narcotics or IV medication.
If you answered "no" to any of the questions above, please explain here.
Your answer
Athlete Information
Date of birth: *
MM
/
DD
/
YYYY
Gender:
Your answer
School: *
Your answer
Grade: *
Visual impairment diagnoses/ details: *
Your answer
Please list all secondary disabilities or diagnoses: *
Your answer
Please list all health conditions or diagnoses: *
Your answer
Where did you find out about Camp Abilities PA? *
Your answer
Parent Contact Information
If child has more than one residence, please provide the parent name and address to which you would like forms sent under parent/ caregiver name(s) #1, and then alternate information under parent/ caregiver name(s) #2. We often use email to communicate, so this information is especially important.
Parent/ caregiver name(s) #1: *
Your answer
Address: *
Your answer
Phone number(s): *
Your answer
Email address: *
Your answer
Parent/ caregiver name(s) #2:
Please use this line if child has more than one residence.
Your answer
Phone number:
Your answer
Email address:
Your answer
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