A-2023 Camp Bluebird Interest Form for Prospective Families

The Camp Bluebird Online Interest Form should be filled out and submitted online for each student interested in attending Camp Bluebird
About Camp Bluebird

Camp Philosophy

The Camp Bluebird Program is designed to foster the social, emotional, physical, sensory, and intellectual well-being of each child through our program on a farm based setting. Our focus is on creating a safe and nurturing environment that offers opportunities for exploration and discovery. We strive to develop curiosity, imagination, self-esteem, caring for others, and the ability to play both cooperatively and independently. We are committed to expanding community access to recreational and social programs for children with developmental disabilities.

The program is multi-sensory. At Camp Bluebird, experiences are provided in a fun, structured, and encouraging environment to encourage growth in the following areas:

• Life Skills

• Social Skills

• Play Skills

We also include a healthy dose of fine & gross motor coordination (outside play time twice a day around the farm), sensory integration, cognitive & adaptive skills, socio-emotional development, and language development every day — all through lots and lots of fun and play!

Program

The program emphasizes the development of the “whole child.” Learning activities are designed to match the developmental stages of each child, regardless of age. Attention is directed at the process and pleasure of discovery in each project, and NOT on the final product.

Quality teachers and staff offer an integrated approach to recreation and learning, skillfully building on what children can do, and challenging them to try new things. Animal care, horticulture, art, music, simple cooking, science, movement, dramatic and imaginative play, creative activities, life skills, social skills, and play skills are linked together as they are explored, all while having fun on our 28-acre farm. Camp Bluebird will incorporate therapeutic ideals from many disciplines: therapeutic recreation, TEACCH, Applied Behavioral Analysis, Verbal Behavior, and Sensory Integration. However, Camp Bluebird is not a mental health program or a treatment program, we are strictly recreational. While our staff and volunteers attend introductory training, they do not implement therapeutic programs. Rather our goal is for the staff to have an understanding of these methods and to incorporate these ideas into daily recreational and learning activities.
CHILD INFORMATION:
Child's Name*

First Name Last Name
Birth Date*

Month Day Year
Grade*
Name of School*
Classroom type

AUCCKCCREDmodEDmildEDsevOther, please explain
Please explain classroom type if "other" was chosen above.
Does your child currently have a 1:1 aide in the classroom, or has your child been approved for a 1:1 aide in the classroom?

YesNo
If yes, please indicate the reasons.
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number*

Area Code Phone Number
E-mail*
How did you hear about us?
MEDICAL INFORMATION
Is autism the primary or secondary diagnosis?
Does your child have epilepsy and suffer from epilepsy seizures?

Grand MalAbsenceMyoclonicClonicTonicAtonicNone
Additional Medical information we should know
Camp Information
Session(s) interested (click all that apply)

Winter track-out sessionSpring track-out sessionSummer track-out sessionFall track-out SessionTraditional school calendar summer session(s) (June & August; for traditional calendar families only)
Additional information

It is our goal to meet the needs of your child from the very beginning of our program. Any information you're able to provide us is an invaluable teaching tool and makes it that much easier for us to help your child be successful. We greatly appreciate your time and honesty.
Which Group To Register your child?

Our goal is to provide a Farm Camp environment that is fun and meaningful for each participant. Our observations have led us to understand that we can provide a better, more enjoyable experience for participants by maintaining a balance of two different groups together in our activities at camp.

By maintaining a balance of two groups, we can tailor activities more precisely so that individual participation might increase and, as a result, be more enjoyable for all. We understand that you know your child the best, and we feel confident that you will choose the best group for your child. However, if you feel that you need our guidance in helping you with your decision, we are more than happy to help. Also, after your initial tour, we may offer guidance as to which group we feel that your child would reach his/her fullest potential at Camp Bluebird.

If you have questions or need additional information, please don't hesitate to give us a call.

GROUP A: (Autism I & II): Criteria for Group A Participants (Child, teen or young adult on the autism spectrum demonstrates ALL or MOST of the following):

	YES	NO
Is willing &/or able to participate in group activities that require conversational skills
Is independent in all or most daily living skills (toileting, eating, dressing)
Is able to follow verbal instructions
Is able to verbalize wants and needs
Is able to remain in an open space without wandering or running
Can be paired in small groups

GROUP B: (Autism III): Criteria for Group B Participants (Child, teen or young adult on the autism spectrum demonstrates ALL or MOST of the following):

	Yes	No
Eats inedible objects (Pica)
Demonstrates disruptive behaviors that interrupt the event or has "meltdowns"
Is unwilling &/or unable to participate in group activities that require conversational skills
Is dependent in all or most daily living skills (toileting, eating, dressing)
Is unable to follow verbal instructions
Is unable to verbalize wants and needs
Is unable to remain in open space without wandering or running
Has a tendency to wander or run away
Has sensitivity to noise, or a tendency to become easily over-stimulated or stressed
Needs 1:1 supervision at all or most times

Based on the above criteria, which group do you believe your child will be attending?

Group A (Autism 1 or 2)Group B (Autism 3)
Type a question
Should be Empty:

The Camp Bluebird Online Interest Form should be filled out and submitted online for each student interested in attending Camp Bluebird

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Camp Information

Additional information