2025 Summer Day Camp-Barnyard Palooza

Welcome to Good Works Farm's

Barnyard Palooza

2025 Summer Day Camp!

We're excited to welcome back old friends and meet some new friends this year!

DATES/TIMES:  Monday - Friday, June 9-13, 2025; 9 am. - 2 pm.

LOCATION:  Good Works Farm, 1566 Roxanna New Burlington Rd., Waynesville, OH 45068. Please note: this is a farm and we are outdoors all day. We provide portable restrooms, handwashing stations, and hand sanitizer.

THEME: It's a Barnyard Palooza! Farm-themed activities will take place at activity stations and throughout camp!

WHO:  Individuals, age 5 and older with a developmental disability (Autism, Down Syndrome, intellectual delay, Fragile X, etc.) and their typical siblings.

COST: $353/week/camper. We accept Medicaid Waiver funding, county funding, grant funding, and private pay. Thanks to the generosity of our Camp Sponsors, we may have a limited number of camp sponsorships from businesses in the community, which will be disbursed contingent upon availability.

TRANSPORTATION: We do not provide transportation.

We accept Ohio Medicaid Waiver Funds for Community Respite, County Funds, Grant Funds, and private pay.  Payment Plans are available.  A campership fund (provided by local corporate and private donors) is available to assist with self-pay fees until funds are depleted.

**Attention Medicaid Waiver Clients**-Please contact your SSA to update your camper's ISP to include Good Works Farm as your Community Respite provider and ensure everything is in place to secure appropriate camp funding.

APPLICATION PROCESS
To ensure that we accept only those individuals that we can serve, we utilize the following process:

1. The family completes an application which lists the camper's physical, developmental, and behavioral needs (please be honest!)

2. Good Works Farm evaluates these needs to determine if we can serve him/her, based on:

a. space available

b. volunteers/staffing available

c. mobility needs

d. medical needs/bathroom independence

e. safety concerns

3. Good Works Farm notifies the family of acceptance, acceptance with conditions, places him/her on a waiting list, or notifies them that GWF cannot meet his/her needs at this time with the prohibitive reasons.

4. If accepted, additional forms will be sent to the family that must be completed prior to attendance: a. Medical Information/permission to treat b. Liability Release Form c. other forms as needed

5. Family will receive an invoice for camp fees due along with funding sources available and due dates. Final camp payment is due no later than the first day of camp, unless arrangements are in place to pay with Ohio Medicaid Waiver or County Family Support Services funds. Refunds are issued on a case by case basis.

PARENT/GUARDIAN INFORMATION
If there are more than two, just list main contacts
Parent/Guardian's Name*
Phone Number*
Email*
example@example.com
Second Parent/Guardian's Name
Phone Number
Email
example@example.com
Client's Mailing Address*

Street Address Line 2

Street Address Line 2

CityState / Province

Postal / Zip Code

If you have more campers to add, please submit this application and begin a new application

You may go back and amend any of the information in this form at this time.
If you are finished, please hit SUBMIT below.
Should be Empty:

APPLICATION PROCESS

PARENT/GUARDIAN INFORMATION

Camper #1

Camper #1 Buddy Information

Camper #2

Camper #2 Buddy Information

Camper #3

Camper #3 Buddy Information

If you are finished, please hit SUBMIT below.