2025 iCare Camper Application

iCare Ministries Camper Application
Welcome to Camp iCare Registration!

Camp iCare is a Catholic camp for persons with developmental disabilities located at the Rotary Camp in Lee’s Summit, Missouri, about 30 minutes East of Kansas City. We will engage in various outdoor activities such as swimming and hiking, as well as the faith activities of prayer and Catholic community building. Camp iCare is a ministry of iCare Ministries, Inc. a 501c3 headquartered in Overland Park, Kansas. Camp iCare is an adventure into the outdoors, and an adventure into your relationship with yourself, Jesus Christ, and others.

Date: June 11-13, 2025

Your Camper's Behavioral Health

Please be detailed and honest in your assessment as your child’s success at camp may depend in a large part on your answers.
My camper has a history of:
Please provide more information for each item selected above.
Has your child been hospitalized for mental illness in the past year?*

YesNo
Does your camper have physically aggressive episodes?*

YesNo
How often do they have episodes?
How long do they typically last?
What triggers an aggressive episode for your camper?
Why does your camper typically engage in these behaviors?
Please also describe what type of aggressive behavior they have. For example; biting, hitting, pinching, etc.
What typically helps your camper calm down?
Is there any more information about these episodes that we should be aware of?
Does your camper have behavior supports in place at home/school/work?

YesNo
Tell us more!

Medical Information
What is your camper's primary diagnosis?*
What is the current weight of your camper?
Are there any activities the camper is restricted from participating due to medically related issues?
Does your camper have a special diet?*

YesNo
Tell us more about the special diet:
Is your camper allergic to any foods?*

YesNo
What food is your camper allergic to?
Please list any preferred foods your camper has:
What medications does your camper take, and when do they take them?
Does your camper use a C-PAP machine?

YesNo
If yes, tell us more.
How does your camper best take instructions?
On average, how many hours does your camper sleep at night?

How verbal is your camper?*

NonverbalReservedModerate CommunicatorTalkative
If your camper has behavioral issues, please select the level of severity:

Low SeverityMedium SeverityHigh Severity
If you selected any of the above options, please provide more information of the behaviors we might experience as well as what can trigger these behaviors:
Please provide direction regarding how to help your camper maintain self-control.
If you wish, please provide more information about your camper's care needs in this area.
Does your camper require the use of sensory items or have a self-soothing routine?*

YesNo
Please provide more information about your camper's care needs in this area.

Care Needs for Activity of Daily Living

The more information we have regarding your camper’s needs the better care we can provide them while they are with us. Please provide as much information regarding your camper's needs in each area. You will have space after each question to write out any routines or further explain the level of assistance needed.
What level of assistance does your camper require when using the restroom or showering?
Does your camper have any issues with constipation? If so, what measures do you take to address the same? Please list any medications or modifications to diet or activities that you use to address constipation issues.
What level of assistance does your camper require while getting dressed?
What level of assistance does your camper require with feeding themselves?
How many hours of rest does your camper need during the day?
Use this space to list ANY special instructions or daily routines we should follow to help us better care for your camper.

Marketing & Media
I give Camp iCare permission to use my child's image and likeness in marketing materials.*

YesNo
Signature*

Clear
Date*

MonthDayYear
Date
Print Name*

First NameLast Name
Should be Empty:

iCare Ministries Camper Application