A-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

revised 08/2025
About Camp Bluebird

Camp Philosophy

Camp Bluebird is designed to foster the social, emotional, physical, sensory, and intellectual well-being of each child through our structured activities 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 activities for children with developmental disabilities.

The activities are 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!

Structured Activities

Camp Bluebird activities emphasize 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.
Please initial to acknowledge understanding that we are not accepting applicants that currently have or have been approved for a 1:1 aide , had a request submitted for a 1:1 aide on their behalf, or that would require the necessity of a 1:1 aide for physical or behavorial reasons at school. Our indoor facilities are not equipped for wheelchair accessibility. By initialing and proceeding with this form you are verifying your child does NOT qualify for any of the aforementioned situations. If your child is accepted into any Camp Bluebird session and it is determined that your child has, requires, and/or is in waiting for a 1:1 aide any and all placement for your child at camp Bluebird or any 3BBF activity can be immediately ceased with no return of any financial deposits, payments or fees.
Initials*
CHILD INFORMATION:
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
Classroom type*

AUCCKCCREDmodEDmildEDsevOther, please explain
Please explain classroom type if "other" was chosen above.
If your child currently has a 1:1 aide in the classroom, if you have requested a 1:1 aide for your child or your child has been approved for a 1:1 aide in the classroom the active and predominantly group based activities , many of wich take place

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

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*
How did you hear about us?
MEDICAL INFORMATION
Is autism the primary or secondary diagnosis? (Camp Bluebird as a division of 3 Bluebirds Farm provides recreational camp for children on the autism spectrum. Those without an autism diagnosis are not eligible to attend.)*
Does your child have epilepsy and suffer from epilepsy seizures?

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

Fall track-out sessionWinter track-out sessionSpring track-out sessionSummer Track -out sessionTraditional school calendar Summer session 1-JuneTraditional school calendar Summer session 2-August
Additional information

It is our goal to meet the needs of your child from the very beginning. 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.
Although we do not force participants to hold animals, we are a farm. There are animals living on the inside and outdoor areas of the property. Exposure and close proximity to animals is part of the daily schedule at camp. It is common for children to join us that do not have pets at home and/or are apprehensive about being around different animals. With patience, understanding and methods of slow introduction we introduce participants to the animals. However, if your child has an extreme fear of animals that results in screaming and/or aggressive reactions towards animals Camp Bluebird will not be a good fit. We promote positive interactions between participants and animals. We do not want to create a scenario in which our animals are defensive towards participants or participants associate animals with negative behaviors.
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 children with varying abilities across the spectrum.

By maintaining a balance we can tailor activities that can be enjoyed by a group and be appealing to individuals with the result of increased participation and a more enjoyable experience for all.

Although there are times during our day that we model, practice, and, encourage independent play and living skills, it is important families understand that we are a recreational camp providing for a group. There are times scheduled into our day and areas within our space to unwind and decompress from possible overstimulation. Please answer the questions below based on the most common tendencies of your child. Add any additional comments in the "Notes & Questions " section.

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

All questions must be answered,contact us with any questions.*

	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
Eats inedible objects (PICA)
Demonstrates disruptive behaviors that interrupt the event or has "meltdowns"
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
Shows interest in engaging with peers
Shows interest in animals
Has a negative reaction or shows fear towards animals
Is able to be and remain calm without the assistance of technology (Ex: IPAD, phone, etc)

Notes & Questions
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