Camp Questionnaire - Growing Healthy Seasons

Main Contact Info

Name

First

Last

Email

Phone

Emergency Contacts

Emergency Contact 1

Same as above

Use my contact info above

Name

First

Last

Phone

Email

Emergency Contact 2: Secondary emergency contact required.

Emergency Contact Name

Emergency Contact Phone

Special Instructions for Emergencies

Child Name(s) and Age(s)

Child 1 Name

Child 1 DOB

Child 2 Name

Child 2 DOB

Child 3 Name

Child 3 DOB

Child 4 Name

Child 4 DOB

Child 5 Name

Child 5 DOB

Creating Affirming and Supportive Experiences

We like to get to know our wonderful campers and all the things that make them unique and amazing! Please help our team get to know your child better:

1. What activities at home/in the community bring joy to your child?

2. What are your child’s strengths?

3. How do you help your child to feel safe and regulated at home/in the community?

4. What helps your child to connect with others (adults and children)?

5. If your child has a history of challenging behaviors such as elopement or aggression, please let us know more about these behaviors so we can support their regulation and meet their needs.

Elopement

Aggression

Other Challenging Behaviors

None of the above applies.

5b. What are the challenging behaviors?

5c. What is this behavior typically communicating?

5d. Are there things that commonly trigger this behavior?

6. My child needs assistance with:

Toileting

Adaptive Communication

Adaptive Mobility

None of the above applies.

Toileting or Toilet Hygiene assistance info (put "N/A" if this does not apply):

Adaptive Communication Equipment info (put "N/A" if this does not apply):

Adaptive Mobility info (put "N/A" if this does not apply):

Please indicate any unique allergy, medication, and/or health information our staff needs to be aware of:

Important medical alert!

Allergies

Special Medication During Camp (if they are bringing it to camp)

Other Health Info/Precautions

None of the above applies.

Allergy info (put "N/A" if this does not apply):

Medication info (put "N/A" if this does not apply):

Other Health info/precautions (put "N/A" if this does not apply):

Reservation is confirmed when Camp Payment (Step 2 of 2) is made.

I understand I need to complete Step 2 of 2 (Camp Payment) to secure my child's spot at camp.

For ALTA Families: ALTA is subsidizing my camp registration.

ALTA Service Coordinator First Name

ALTA Service Coordinator Last Name

ALTA Service Coordinator's Email

ALTA Service Coordinator's Phone

Copy of Responses

Please send me a copy of my responses.

Contact Me

Please contact me; I have additional questions before camp.

Note: If for some reason your browser is unable to submit the form online (ie. due to a recaptcha or form submission error), please contact us at care@growinghealthyseasons.com and we will email you the form to complete. (You can also download the form to manually complete here and then email to us. Download the form first in order to complete and email.)

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Main Contact Info

Emergency Contacts

Child Name(s) and Age(s)

Creating Affirming and Supportive Experiences

We like to get to know our wonderful campers and all the things that make them unique and amazing! Please help our team get to know your child better:

Please indicate any unique allergy, medication, and/or health information our staff needs to be aware of:

Title