RVSRA Camp SOAR Application Form
SOAR- Social Opportunities and Recreation
Participant Information
Name
First Name
Last Name
Age
School Last Attended
Gender
Please Select
Male
Female
N/A
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent(s)/Guardian(s) Information
Please list in order of whom to contact first
*
Disability Information
Please check all that apply:
Attention Deficit Disorder
Down Syndrome
Specific Learning Disability
Autism
Emotional/Behavior Disorder
Traumatic Brain Injury
Cerebral Palsy
Intellectual Disability
Visual Impairment
Deafness/Hearing Impairment
Other
If "other":
What are your participant's specific needs related to their disability?
Medical Information
Does your participant take any medication?
Yes
No
If "yes", please list medications:
Does your participant have any medical conditions or allergies we should be aware of? (Please list)
Does your participant require any special medical treatments, therapies, or procedures while at camp? (Yes/No) If yes, please describe:
Does your participant use any medical equipment or assistive devices (e.g., wheelchair, hearing aid, etc.)? (Yes/No) If yes, please list:
Accommodations and Support Needs
Are there any behavioral, emotional, or communication needs that we should be aware of to best support the participant?
How does the participant communicate? (Verbal, non-verbal, AAC device, sign language, etc.)
Do you feel the participant will be successful in a 4:1 camper/ staff ratio?
Yes
No
If "no", what supports does your participant require to have a successful summer camp experience?
Does your participant require assistance with toileting and/or feeding?
Yes
No
If you answered "Yes" to the question above, please answer the next questions regarding PCA's.
RVSRA Camp Staff do not provide assistance with toileting and/or feeding. Personal Care Attendants (PCA's) will be required for participants who require 1:1 assistance for feeding and toileting. Does your participant need a PCA?
Yes, I am requesting my participant's School District provide a PCA.
No, I will provide a PCA for my participant.
Behavioral and Social Needs
Does your participant have any specific social or behavioral challenges (e.g., difficulty with social cues, anxiety in group settings, etc.)?
What strategies or techniques work best for helping your participant manage challenging behaviors or situations?
Camp Participation Preferences
What type of camp activities does your participant enjoy? (e.g., swimming, arts and crafts, nature walks, sports, etc.)
Are there any activities that your participant may have difficulty with or should avoid? (Please explain)
Transportation
Camp SOAR will be held at the RVSRA Office: 1335 E Broadway St, Bradley. Will you be able to provide your participant with transportation to and from camp?
Yes
No
Will your participant require special transportation arrangements? (Yes/No) If yes, please explain:
Is there anything we should know about your participant's transportation needs (e.g., wheelchair accessibility, assistance needed)?
Additional Information
Is there anything else the camp staff should know to ensure your participant's safety, comfort, and success at camp?
Do you have any questions/ concerns about Camp SOAR?
2025 Camp SOAR Programs
Please check the Session(s) you are applying for:
Rows
Session 1 (June 9th to July 3rd)
Session 2 (July 7th to July 31st)
Teen Camp (13-17 YO)
Adult Camp (18-21 YO)
Date Application Was Submitted:
-
Month
-
Day
Year
Date
Submit
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