Summer Camp information form
To help our camp staff create the best possible experience for your child, please take a few moments to complete this form with as much detail as you can. A completed form is required for every child attending our day camp. Camp fees will be invoiced the week prior to your selected camp dates and are due before camp begins each Monday.
Name of child
*
First Name
Last Name
Does your child have a nickname they like to be called? What is it?
Age of child
*
Child's birthday
What camp will your child be attending:
K - 2nd grade
3rd grade +
What size shirt does your camper wear?
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult S
Adult M
Adult L
What mental or physical health diagnoses (if any) does your child have?
*
How does your child communicate? Is there anything the camp should know about your child's communication? (verbal, written, sign language, talk to text device, AAC device, etc..)
*
Please share with us ways to positively work with your child. What can a camp staff do to ensure your child has a good experience? Does your child have any positive coping skills that they use or like to use?
*
Please share with us ways that the day camp worker should not work with or communicate with your child? What does your child NOT like?
*
Does your child require assistance with any of the following:
going up or down stairs
putting on or tying their shoes
opening snacks or drinks (provided by parent, no peanut products please)
transitioning from wheelchair to foam pit, trampoline, crash pad or swing)
bathroom assistance (if clicked, please explain below)
If you clicked bathroom assistance, what assistance would they require?
Does your child have any allergies? If so, to what?
*
Will your child need to take any medication while at the Sensory Zone? All medications will need to be in original bottle with full instructions and kept at the front desk during respite.
Yes
No
What type of medication may your child need to take while at the Sensory Zone? All medications will be administered by lead staff on site that day according to instructions provided.
Which of the following can the staff at the Sensory Zone adminster to your child?
ice pack
tylenol (childrens)
basic medical attention (scratches, bumps, bruises)
cough drop
popsicle for sore throat
Emergency medical attention by training professional (if needed) Guardian will be called if anything happens requiring medical assistance.
What hobbies or interests does your child have?
*
What else would you like the camp staff to know about your child?
*
Other infomation not asked for that you feel is important:
*
Parent #1 Information
First Name
Last Name
Phone Number:
Email
example@example.com
Parent #2 Information
First Name
Last Name
Phone Number:
Email
example@example.com
Emergency Contact person (non guardian to contact in case of an Emergency)
*
First Name
Last Name
Emergency Contact phone #
*
Please enter a valid phone number.
Format: (000) 000-0000.
Who IS allowed to pick up the child?
Who is NOT allowed to pick up the child?
I allow the Sensory Zone to take pictures of my child engaged in activities for Sensory Zone marketing purposes? (If yes, please sign)
Attendance Policy: To ensure we can maintain appropriate staff-to-child ratios and provide consistent care for all children and families, we ask that attendance be taken seriously. If you are unable to attend your scheduled camp day, please notify us as soon as possible by texting the program cell at 608-640-8432.
*
Behavioral Agreement: The safety of all children and staff at the Sensory Zone is of the utmost importance. To maintain a safe and supportive environment, the Sensory Zone enforces a zero-tolerance policy regarding destruction of property or harm to others. If a child displays behaviors that include damaging property or physically harming another child or staff member, an immediate call home will be made. The child will be separated from all other children while waiting for a parent or guardian to pick them up. Future attendance in respite or any Sensory Zone programs will be discussed on an individual basis to determine the child’s ability to safely participate moving forward. Thank you for your understanding and support in keeping our space safe for everyone.
*
Field Trips: I allow the Sensory Zone to take my child out of the Sensory Zone on a walking/driving field trip if provided all the details prior to the field trip? (If yes, please sign)
*
Submit
Should be Empty: