2024 Camper Application

2025 Camper Application
A $275 refundable deposit via check or Zeffy is required before we review your camper application. The remaining balance is due upon acceptance. Make checks payable to Avanti Therapeutic Projects and use the mailing address on our website. If planning to use our Zeffy site, you will automatically be redirected upon submitting this application.

** Please note that Zeffy is a free site for non-profits. In return they make a suggestion for a contribution at check out, but there is no obligation to do so. **

The camper review committee will start processing applications mid-January.
Applications will be reviewed in the order they are received and on a rolling basis until
slots are filled.
Please either take a photo of your camper using the button below or upload a photo of your camper. You do not need to do both.
Take Photo of CAMPER
Upload Photo of CAMPER
Which camp program are you applying for?*
We will consider slots for 14 & 15 year olds if we have space and staffing.
Past Avanti Camper
Camper's Name*

First NameLast Name
Camper's Preferred Name
Camper's Gender*

FemaleMaleOther
Camper's Birth Date*
00/00/0000
Parent/Guardian Name(s): Primary home (if camper splits time between homes)*
Relationship to Camper*
Preferred Phone Number*
Alternate Phone Number
Email Address*
example@example.com
Primary Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County of Primary Home*
Parent/Guardian Name(s): Secondary home (if camper splits time between homes)
Preferred Phone Number: Secondary Home
Alternate Phone Number: Secondary Home
Email Address: Secondary Home
example@example.com
How did you hear about camp?*

Medical Information

This information will assist the camper review committee in determining if Camp Avanti is a good fit for your child. If accepted, more in-depth medical information will be requested.
Please list any medical/psychological diagnosis for camper.*
Has your camper been hospitalized over the last year? If so, please explain.*
Please list any current medication and treatment.*
Please list any diet limitations (including sensitivities, allergies, limited eating habits, feeding tube, etc.*
Please explain any vision or hearing challenges.*
Does this camper have any activity or swimming restrictions/limitations? If yes, please explain.*
Please explain any communication challenges which your camper might have.*

For Returning Campers Only
Granters and other funding sources frequently want feedback on past progress including feedback from parents. Please check the areas where you saw progress after the last camp session your child attended. Then give brief descriptions. Thank you!
Areas of progress

Independence with tasksInitiationMotor skillsCalm focus/attentionSelf caresSocial interactionsEmotional control
Comments:

Financial Aid: Camper Scholarship*

A scholarship may be needed; please send an application to usNo need to send scholarship application; we have other financial avenues
** Request for financial support will not affect camper eligibility. **
If you plan to utilize waiver funds through your county (i.e. CLTS - Long Term Support waiver, etc), please indicate that below. Identify the county, your case manager, and contact information for the case manager which will assist in ensuring all necessary paperwork is in place.
** Make sure you inform your case manager about this application and that an Avanti administrator will be reaching out to ensure funding paperwork is in place **
By signing below, I attest that the completed information is accurate.
Signature*

Clear

Permission to contact a professional at my child's school
I hereby give permission for Camp Avanti administrative staff to contact a professional at my child's school (listed below) who is familiar with them. I understand that the information obtained will be used for the sole purpose of determining the level and type of support needed for a successful camp experience for my child.
Permission:*

YesNo
Person to contact (at the school):
Job/Role:
Phone Number
Please enter a valid phone number.
Signature*

Clear
Should be Empty:

2025 Camper Application

Medical Information

School Information

Stress Management/Coping

Additional Information

Therapy

Self Care Skills

For Returning Campers Only

Permission to contact a professional at my child's school