Camp Sensory House Registration from 
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Email *
Please Check the week(s) your camper will attend *
Required
Child's Name first and last *
Does your child have a preferred name or nickname?
Date of birth / current age *
MM
/
DD
/
YYYY
Gender *
Diagnosis (optional)
Parent/Guardian Information
Name(s)
 *
Relationship to Child *
Phone number (primary) *
Email *
Home address *
Emergency Contact (other than parent/guardian)
Name
 *
Relationship to child *
Phone number *
Medical and Allergy Information
Does your child have any allergies
Clear selection
If yes to the above question please explain *
Does your child have any medical conditions? If yes, please explain.  *
Medications taken regularly (if any) *
Sensory & Communication Support
Sensory Sensitivities (Yes/No). If yes, please describe.
 *
Preferred communication style (verbal, gestures, AAC, etc.) *
What are some strategies that help with transitions or regulation? *
Pick-Up Authorization
Please List Person 1 Name/Phone/ Relationship to Child
Person 2 Name/Phone/ Relationship to Child
 *
Photo & Video Release Waiver
Used for social media, webpage, etc...
 *
Please click the link above to submit payment, Thank you!
Agreement & Signature *
Required
Parent/Guardian Signature *
Submit
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