Camp Abilities Tucson Athlete Interest Form

To apply for Camp Abilities Tucson 2021, fill out the following form and we will be in contact with you after January 1, 2021.

Athlete name: *

Athlete birth date: *

YYYY

Visual Impairment Diagnosis/ Acuity: *

Does your athlete have any secondary disability diagnoses or health conditions? *

Please list and explain all diagnoses.

What is the athlete's primary language? *

Spoken English

ASL

Spanish

Other:

Please check "yes" or "no" for each of the following items. *

If "no", please explain below.

Yes

My child has a vision teacher and a diagnosis of blind or visually impaired.

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 does not have behaviors that interfere with the safety of others, such as eloping, biting, hitting, kicking, or scratching.

My child can sustain physical activity for several hours at a time, six days in a row.

My child is free of medical conditions that require treatment with narcotics, injections, or IV medication.

Yes

My child has a vision teacher and a diagnosis of blind or visually impaired.

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 does not have behaviors that interfere with the safety of others, such as eloping, biting, hitting, kicking, or scratching.

My child can sustain physical activity for several hours at a time, six days in a row.

My child is free of medical conditions that require treatment with narcotics, injections, or IV medication.

Explanation of above responses, if applicable:

Parent/ Guardian Name(s): *

Best contact phone number: *

Best contact email address: *

Home address where forms should be sent:

If you want physical copies of the forms rather than electronic copies. Please note that some forms will have to be printed to get signatures.

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