GSR Summer Camp Inquiry Form

Summer Camp Inquiry Form

Please complete the below information to the best of your knowledge. It is important all information be representative of your child's skills to ensure their ability to receive the most benefit from this camp.
Camper's Name

First NameMiddle NameLast Name
Parent Name

First NameLast Name
Camper's Birth Date

MonthDayYear
Gender
Parent's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's E-mail
example@example.com
Parent's Mobile Number
Format: (000) 000-0000.
Upload Driver's License:

Cancelof
Week 1: Superheroes and Wizards June 16-20 (Cost $250 until 2/21, then $300)Week 2: Enchanted Odyssey June 23-27 (Cost $250 until 2/21, then $300)Week 3: Nature and Camping July 7-11 (Cost $250 until 2/21, then $300)Week 4: Olympics and Movement July 14-18 (Cost $250 until 2/21, then $300)Week 5: Around the World July 21-25 (Cost $250 until 2/21, then $300)Week 6: Beach/Ocean July 28-August 1 (Cost $250 until 2/21, then $300)
NoYes
If you answered "Yes" to the above question please describe your child's allergies and/or medical conditions below:
Our goal is to foster an inclusive, diverse environment for all campers. Due to the group nature of our program, we have established some guidelines to ensure that each child is set up for success in this setting. Please answer the following questions.
Where does your child attend school?
What Grade is your Child in?
Yes, my child is potty trained and need no assistance in the restroomYes, my child is potty trained but occasionally requests help in the restroomNo, my child is not potty trained or needs frequent help in the restroom
Yes, My child can unpack and eat their lunch safelyYes, My child needs age appropriate assistance opening their lunch but they are safe and independent with eatingNo, My child is not independent and needs 1 on 1 assistance with eatingMy Child will not be eating at camp
Yes, my child can follow verbal directions with 2 or more steps and is safe in a group settingYes, my child is able to work in a group setting but for limited amounts of time and needs frequent breaks or redirectionsYes, my child loves being in a group, but needs to be watched very closely at all times to ensure their safety and/or needs physical assistance to complete activities such as crafts and gamesNo, my child needs one on one attention in all settings
It is important to us that all children who participate in camp are safe and their needs are fully understood. If your child has any special safety concerns please note these below (Ex: My child frequently wanders off from groups, my child has sensory needs and in loud groups can get overwhelmed etc.)
What is one thing you would like for your child to get out of this camp?
Additional Comments/ Additional Pick-up/Dropoff person?
Thank you for completing our GSR Summer Camp inquiry form. Our summer camp leaders will review your information and call you to answer any additional questions and confirm your placement in camp. At this time, GSR reserves the right to accept or deny camper's based on availability in the camp and concerns for safety of the camper based on their abilities. By submitting this form, you are not yet signed up for camp. It is GSR's responsibility to ensure all campers have the appropriate prerequisite skills to get the most out of this camp. Once this process is complete and availability for your requested dates is confirmed you will be provided a final sign up sheet via email. Please complete this form and include credit card payment to reserve your child's slot. Thank you.
Signature

Clear
Should be Empty:

Summer Camp Inquiry Form

Our goal is to foster an inclusive, diverse environment for all campers. Due to the group nature of our program, we have established some guidelines to ensure that each child is set up for success in this setting. Please answer the following questions.