School Report for Elks Camp Grassick

  • School Report for Elks Camp Grassick

    This form is to be completed by the child's classroom or special education teacher. This report is for Elks Camp Grassick use only.

  • Identifying Information

  • What camp session is this individual applying to?
  • Birthdate*
     - -
  • Format: (000) 000-0000.
  • Will the child attend this school next year?*
  • Rows
  • This individual is receiving or could benefit from:

  • Information from Camp

  • I would like to receive a copy of the acceptance or non-acceptance letter and pre-camp information:*
  • If this individual is accepted, I would like to receive a copy of the report and follow up information after camp:*
  • How would you like to receive information from camp?

  • Information on Activities of Daily Living

  • Activities of Daily Living:

    Definitions:

    Independent – Individual is able to complete the task with no assistance and little to no prompting.

    Supervision – Individual is able to complete task with some prompting or reminders.

    Minimal Assistance – Individual needs frequent prompting, step by step instructions, and/or some physical assistance to complete the task.

    Moderate Assistance – Individual needs physical assistance to complete the task.

    Total Assistance – due to physical limitations or skill deficits, the individual is unable to complete the task and it must be done for them.

  • Rows
  • How does this individual communicate?*

  • Social Study

  • Rows
  • Has this individual ever attended summer camp before?*

  • Behavior Study

  • On a typical day, how much time is this individual at their behavioral baseline?
  • Does this individual exhibit any unexpected behaviors (discipline problems, periods of dysregulation or responsiveness to consequences) in his/her school environment?*
  • Does this individual have any repetitive behaviors, stims, or tics?*
  • Please check the behaviors that this individual exhibits when dysregulated. Note: Please be honest. These behaviors do not automatically disqualify an applicant, and these questions help us to better serve our campers.
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • Reading Report

    To be completed if this individual could benefit from reading intervention while at camp.

  • Please note:  Although most children would benefit from some type of reading instruction while at Camp Grassick, only so many are selected to receive individual help in reading because of the number of instructors that we have available.  Even if this child is not selected to receive individual reading instruction, they will still benefit from reading activities promoted within their cabin and cabin group.

  • Reading Instructor Information

    Please complete this portion if the reading instructor is different from the person who filled out the school report.
  • I would like to receive a copy of the acceptance or non-acceptance letter and pre-camp information:
  • If this individual is accepted, I would like to receive a copy of the report and follow up information after camp:
  • How would you like to receive information from camp?

  • Reading Intervention Information

  • Does this child receive special reading instruction or reading intervention?
  • Reading Intervention: Please check if the student needs support in any of these areas:
  •  
  • Should be Empty: