Treasured Talents Inclusive Summer Camp 2026

1
1st Parent / Guardian Full Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
3
Home Address* This field is required.(Street, City, Sate, Zip)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Email Address* This field is required.Please carefully enter your email address
example@example.com
5
2nd Parent / Guardian (if applicable) Full Name
First Name
Last Name
6
Phone Number
7
Email Address
example@example.com
8
Camper resides with* This field is required.
Both parents
Mother
Father
Guardian/Other
9
Background Information: Provide info on living arrangements, education, health routine, etc.Eg Is the camper in school, Is camper used to group setting, Does camper have health care needs that we must factor in?
10
1st Emergency Contact* This field is required.Minimum 2 persons required
11
2nd Emergency Contact* This field is required.Minimum 2 persons required
12
Pick-up & Drop-off Authorization ListPlease bring a valid photo ID on collection
Full Name
Please enter phone number
Full Name
Please enter phone number
13
How many children are you registering?* This field is required.You may register up to two children from the same household on this form.
1
2
14
Child 1- Full Name * This field is required.
First Name
Last Name
15
Child 1- Date of Birth (MM/DD/YYYY)* This field is required.
Date
Month
Day
Year
16
Child 1 - Age* This field is required.Camper's age on or before July 2
Camper's age on or before July 2
17
Child 1- Select Camper's T-Shirt Size* This field is required.Youth Sizes
Please Select
Please Select
XS
Small
Medium
Large
XLarge
XXLarge
18
Child 1 - Gender* This field is required.
Female
Male
19
Child 1 - Primary Language(s) SpokenLanguages the camper understands and responds to
English
Spanish
Other
20
Child 1- Are there any barriers to communication?* This field is required.
Yes
No
21
If yes, please describe:For Child 1
22
Child 1's LikesList any strong likes the camper has that can be used to encourage participation
23
Child 1's DislikesList any strong dislikes the camper has that we can avoid doing
24
Child 1 - Hobbies & InterestsDo they like specific themes or characters, do they like to draw, paint, sing, read etc
25
Child 1 - Help us understand & plan for our campers' needs* This field is required.
Yes/No
If yes, please describe
1. Does camper have any allergies (food, medical, environmental..)
Yes
No
Row 0, Column 0
Row 0, Column 1
2. Does the camper have any dietary restrictions?
Yes
No
Row 1, Column 0
Row 1, Column 1
3. Does the camper take any medications?
Yes
No
Row 2, Column 0
Row 2, Column 1
4. Any diagnosis or medical condition we should be aware of? e.g. Autism, ADHD, Down Syndrome, Epilepsy
Yes
No
Row 3, Column 0
Row 3, Column 1
5. Is mobility assistance needed? (eg wheelchair, walker, physical support)
Yes
No
Row 4, Column 0
Row 4, Column 1
6. Is communication support needed? (eg AAC device, ASL, simplified instructions)
Yes
No
Row 5, Column 0
Row 5, Column 1
7. Any behavioral or sensory needs? (eg noise sensitivity, transition difficulties, sensory triggers etc)
Yes
No
Row 6, Column 0
Row 6, Column 1
1. Does camper have any allergies (food, medical, environmental..)
2. Does the camper have any dietary restrictions?
3. Does the camper take any medications?
4. Any diagnosis or medical condition we should be aware of? e.g. Autism, ADHD, Down Syndrome, Epilepsy
5. Is mobility assistance needed? (eg wheelchair, walker, physical support)
6. Is communication support needed? (eg AAC device, ASL, simplified instructions)
7. Any behavioral or sensory needs? (eg noise sensitivity, transition difficulties, sensory triggers etc)
Yes/No
Yes
No
Row 0, Column 0
If yes, please describe
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
If yes, please describe
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
If yes, please describe
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
If yes, please describe
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
If yes, please describe
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
If yes, please describe
Row 5, Column 1
Yes/No
Yes
No
Row 6, Column 0
If yes, please describe
Row 6, Column 1
1 of 7
26
Child 1 - Are there delays or challenges in any of the following areas?* This field is required.List everything that will help us best prepare for the camper
Yes/No
Brief Description (if Yes)
Social Interactions
Yes
No
Row 0, Column 0
Row 0, Column 1
Expressive Language
Yes
No
Row 1, Column 0
Row 1, Column 1
Receptive Language
Yes
No
Row 2, Column 0
Row 2, Column 1
Personal Care
Yes
No
Row 3, Column 0
Row 3, Column 1
Anxiety
Yes
No
Row 4, Column 0
Row 4, Column 1
Transitioning Between Activities
Yes
No
Row 5, Column 0
Row 5, Column 1
Specific Stimulants / Triggers
Yes
No
Row 6, Column 0
Row 6, Column 1
Interacting with Others
Yes
No
Row 7, Column 0
Row 7, Column 1
Feeding Self
Yes
No
Row 8, Column 0
Row 8, Column 1
Toileting
Yes
No
Row 9, Column 0
Row 9, Column 1
Personal Hygiene
Yes
No
Row 10, Column 0
Row 10, Column 1
Following Simple Directions
Yes
No
Row 11, Column 0
Row 11, Column 1
Reading
Yes
No
Row 12, Column 0
Row 12, Column 1
Identifying Pain or Discomfort
Yes
No
Row 13, Column 0
Row 13, Column 1
Language Development
Yes
No
Row 14, Column 0
Row 14, Column 1
Social Interactions
Expressive Language
Receptive Language
Personal Care
Anxiety
Transitioning Between Activities
Specific Stimulants / Triggers
Interacting with Others
Feeding Self
Toileting
Personal Hygiene
Following Simple Directions
Reading
Identifying Pain or Discomfort
Language Development
Yes/No
Yes
No
Row 0, Column 0
Brief Description (if Yes)
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
Brief Description (if Yes)
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
Brief Description (if Yes)
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
Brief Description (if Yes)
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
Brief Description (if Yes)
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
Brief Description (if Yes)
Row 5, Column 1
Yes/No
Yes
No
Row 6, Column 0
Brief Description (if Yes)
Row 6, Column 1
Yes/No
Yes
No
Row 7, Column 0
Brief Description (if Yes)
Row 7, Column 1
Yes/No
Yes
No
Row 8, Column 0
Brief Description (if Yes)
Row 8, Column 1
Yes/No
Yes
No
Row 9, Column 0
Brief Description (if Yes)
Row 9, Column 1
Yes/No
Yes
No
Row 10, Column 0
Brief Description (if Yes)
Row 10, Column 1
Yes/No
Yes
No
Row 11, Column 0
Brief Description (if Yes)
Row 11, Column 1
Yes/No
Yes
No
Row 12, Column 0
Brief Description (if Yes)
Row 12, Column 1
Yes/No
Yes
No
Row 13, Column 0
Brief Description (if Yes)
Row 13, Column 1
Yes/No
Yes
No
Row 14, Column 0
Brief Description (if Yes)
Row 14, Column 1
1 of 15
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Child 1 - Are there any behavior concerns?* This field is required.List anything that will help us keep the camper and others safe
Yes/No
Brief Description (if Yes)
Tantrums
Yes
No
Row 0, Column 0
Row 0, Column 1
Work Refusal
Yes
No
Row 1, Column 0
Row 1, Column 1
Elopement (running away)
Yes
No
Row 2, Column 0
Row 2, Column 1
Stealing
Yes
No
Row 3, Column 0
Row 3, Column 1
Self-Harm/ Safety
Yes
No
Row 4, Column 0
Row 4, Column 1
Sudden Outbursts (Screaming / Yelling)
Yes
No
Row 5, Column 0
Row 5, Column 1
Tantrums
Work Refusal
Elopement (running away)
Stealing
Self-Harm/ Safety
Sudden Outbursts (Screaming / Yelling)
Yes/No
Yes
No
Row 0, Column 0
Brief Description (if Yes)
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
Brief Description (if Yes)
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
Brief Description (if Yes)
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
Brief Description (if Yes)
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
Brief Description (if Yes)
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
Brief Description (if Yes)
Row 5, Column 1
1 of 6
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For Child 1- If you can stop these behaviors instantly, what do you do?* This field is required.For Child 1
29
Child 2 - Full Name* This field is required.
First Name
Last Name
30
Child 2 - Date of Birth (MM/DD/YYYY)* This field is required.
Date
Month
Day
Year
31
Child 2 - Age* This field is required.Camper's age on or before July 2
Camper's age on or before July 2
32
Child 2- Select Camper's T-Shirt Size* This field is required.Youth Sizes
Please Select
Please Select
XS
Small
Medium
Large
XLarge
XXLarge
33
Child 2 - Gender* This field is required.
Female
Male
34
Child 2 - Primary Language(s) SpokenLanguages the camper understands and responds to
English
Spanish
Other
35
Child 2- Are there any barriers to communication?* This field is required.
Yes
No
36
If yes, please describe:For Child 2
37
Child 2's LikesList any strong likes the camper has that can be used to encourage participation
38
Child 2's DislikesList any strong dislikes the camper has that we can avoid doing
39
Child 2 - Hobbies & InterestsDo they like specific themes or characters, do they like to draw, paint, sing, read etc
40
Child 2 - Help us understand & plan for our campers' needs* This field is required.
Yes/No
If yes, please describe
1. Does camper have any allergies (food, medical, environmental..)
Yes
No
Row 0, Column 0
Row 0, Column 1
2. Does the camper have any dietary restrictions?
Yes
No
Row 1, Column 0
Row 1, Column 1
3. Does the camper take any medications?
Yes
No
Row 2, Column 0
Row 2, Column 1
4. Any diagnosis or medical condition we should be aware of? e.g. Autism, ADHD, Down Syndrome, Epilepsy
Yes
No
Row 3, Column 0
Row 3, Column 1
5. Is mobility assistance needed? (eg wheelchair, walker, physical support)
Yes
No
Row 4, Column 0
Row 4, Column 1
6. Is communication support needed? (eg AAC device, ASL, simplified instructions)
Yes
No
Row 5, Column 0
Row 5, Column 1
7. Any behavioral or sensory needs? (eg noise sensitivity, transition difficulties, sensory triggers etc)
Yes
No
Row 6, Column 0
Row 6, Column 1
1. Does camper have any allergies (food, medical, environmental..)
2. Does the camper have any dietary restrictions?
3. Does the camper take any medications?
4. Any diagnosis or medical condition we should be aware of? e.g. Autism, ADHD, Down Syndrome, Epilepsy
5. Is mobility assistance needed? (eg wheelchair, walker, physical support)
6. Is communication support needed? (eg AAC device, ASL, simplified instructions)
7. Any behavioral or sensory needs? (eg noise sensitivity, transition difficulties, sensory triggers etc)
Yes/No
Yes
No
Row 0, Column 0
If yes, please describe
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
If yes, please describe
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
If yes, please describe
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
If yes, please describe
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
If yes, please describe
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
If yes, please describe
Row 5, Column 1
Yes/No
Yes
No
Row 6, Column 0
If yes, please describe
Row 6, Column 1
1 of 7
41
Child 2 - Are there delays or challenges in any of the following areas?* This field is required.List everything that will help us best prepare for the camper
Yes/No
Brief Description (if Yes)
Social Interactions
Yes
No
Row 0, Column 0
Row 0, Column 1
Expressive Language
Yes
No
Row 1, Column 0
Row 1, Column 1
Receptive Language
Yes
No
Row 2, Column 0
Row 2, Column 1
Personal Care
Yes
No
Row 3, Column 0
Row 3, Column 1
Anxiety
Yes
No
Row 4, Column 0
Row 4, Column 1
Transitioning Between Activities
Yes
No
Row 5, Column 0
Row 5, Column 1
Specific Stimulants / Triggers
Yes
No
Row 6, Column 0
Row 6, Column 1
Interacting with Others
Yes
No
Row 7, Column 0
Row 7, Column 1
Feeding Self
Yes
No
Row 8, Column 0
Row 8, Column 1
Toileting
Yes
No
Row 9, Column 0
Row 9, Column 1
Personal Hygiene
Yes
No
Row 10, Column 0
Row 10, Column 1
Following Simple Directions
Yes
No
Row 11, Column 0
Row 11, Column 1
Reading
Yes
No
Row 12, Column 0
Row 12, Column 1
Identifying Pain or Discomfort
Yes
No
Row 13, Column 0
Row 13, Column 1
Language Development
Yes
No
Row 14, Column 0
Row 14, Column 1
Social Interactions
Expressive Language
Receptive Language
Personal Care
Anxiety
Transitioning Between Activities
Specific Stimulants / Triggers
Interacting with Others
Feeding Self
Toileting
Personal Hygiene
Following Simple Directions
Reading
Identifying Pain or Discomfort
Language Development
Yes/No
Yes
No
Row 0, Column 0
Brief Description (if Yes)
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
Brief Description (if Yes)
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
Brief Description (if Yes)
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
Brief Description (if Yes)
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
Brief Description (if Yes)
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
Brief Description (if Yes)
Row 5, Column 1
Yes/No
Yes
No
Row 6, Column 0
Brief Description (if Yes)
Row 6, Column 1
Yes/No
Yes
No
Row 7, Column 0
Brief Description (if Yes)
Row 7, Column 1
Yes/No
Yes
No
Row 8, Column 0
Brief Description (if Yes)
Row 8, Column 1
Yes/No
Yes
No
Row 9, Column 0
Brief Description (if Yes)
Row 9, Column 1
Yes/No
Yes
No
Row 10, Column 0
Brief Description (if Yes)
Row 10, Column 1
Yes/No
Yes
No
Row 11, Column 0
Brief Description (if Yes)
Row 11, Column 1
Yes/No
Yes
No
Row 12, Column 0
Brief Description (if Yes)
Row 12, Column 1
Yes/No
Yes
No
Row 13, Column 0
Brief Description (if Yes)
Row 13, Column 1
Yes/No
Yes
No
Row 14, Column 0
Brief Description (if Yes)
Row 14, Column 1
1 of 15
42
Child 2 - Are there any behavior concerns?* This field is required.List anything that will help us keep the camper and others safe
Yes/No
Brief Description (if Yes)
Tantrums
Yes
No
Row 0, Column 0
Row 0, Column 1
Work Refusal
Yes
No
Row 1, Column 0
Row 1, Column 1
Elopement (running away)
Yes
No
Row 2, Column 0
Row 2, Column 1
Stealing
Yes
No
Row 3, Column 0
Row 3, Column 1
Self-Harm/Safety
Yes
No
Row 4, Column 0
Row 4, Column 1
Sudden Outbursts (Screaming / Yelling)
Yes
No
Row 5, Column 0
Row 5, Column 1
Tantrums
Work Refusal
Elopement (running away)
Stealing
Self-Harm/Safety
Sudden Outbursts (Screaming / Yelling)
Yes/No
Yes
No
Row 0, Column 0
Brief Description (if Yes)
Row 0, Column 1
Yes/No
Yes
No
Row 1, Column 0
Brief Description (if Yes)
Row 1, Column 1
Yes/No
Yes
No
Row 2, Column 0
Brief Description (if Yes)
Row 2, Column 1
Yes/No
Yes
No
Row 3, Column 0
Brief Description (if Yes)
Row 3, Column 1
Yes/No
Yes
No
Row 4, Column 0
Brief Description (if Yes)
Row 4, Column 1
Yes/No
Yes
No
Row 5, Column 0
Brief Description (if Yes)
Row 5, Column 1
1 of 6
43
For Child 2- If you can stop these behaviors instantly, what do you do?* This field is required.For Child 2
44
How did you hear about Treasured Talents Summer Camp?This helps us know how best to reach others
Website
Social Media
Friend / Family
School
Other
45
Treasured Talents Camp is led by a Christian organization. Bible-based stories and values are woven into all camp activities. Campers are never required to pray or hold any particular belief — children of all faiths and backgrounds are warmly welcomed.* This field is required.By selecting "Yes," I confirm I have read and understood the above.
Yes, I understand
46
Participation Acknowledgement: * This field is required.I give permission for my child(ren) to participate in all activities at Treasured Talents Inclusive Summer Camp 2026, hosted by the YaraStar Foundation, to be held June 29 – July 2, 2026 at Westland Baptist Church, Katy, Texas. I understand the camp includes indoor and outdoor activities such as STEM, arts and crafts, and physical movement activities. I understand all activities are designed with safety and inclusivity in mind and supervised by trained volunteers and professionals.
Yes I give permission
47
Medical Consent & Emergency Care:* This field is required. I authorize camp staff and volunteers to administer basic first aid and seek emergency medical treatment if needed. I understand that efforts will be made to contact me first. I release YaraStar Foundation and its representatives from any liability related to emergency care provided in good faith. Medical details, allergies, medications, and emergency contacts provided in Sections 2 and 4 of this form are incorporated into this consent.
Yes I give permission
48
Behavioral & Safety Expectations:* This field is required.I understand that all children will be treated with respect and care. I also understand that to ensure a safe environment, any behavior that threatens the safety of my child(ren) or others may result in early dismissal from the program. YaraStar staff will always aim to support children through challenges, particularly those related to special needs
Yes I give permission
49
Media Release :* This field is required.I give permission to the YaraStar Foundation, the organizer of Treasured Talents Camp to use photographs and/or videos of my child(ren) captured during camp activities. I understand that these images/videos may be shared on their website, newsletter, social media platforms, or other publications in a respectful manner to inspire others, celebrate my child’s achievements, and help create more opportunities for children like mine.
I GIVE permission for my child's photo/video/creative work to be used in YaraStar Foundation promotional materials
I DO NOT give permission
50
Assumption of Risk & Release of Liability:* This field is required.I understand that while all reasonable safety measures will be taken, participation in camp activities carries inherent risks. I agree to release and hold harmless the YaraStar Foundation, its volunteers, employees, board members, and partnering organizations including Westland Baptist Church from any and all liability for injuries, losses, or damages that may arise from participation, except in cases of gross negligence or intentional misconduct.
Yes I understand
51
Acknowledgement:* This field is required.By signing below, I confirm that I have read and understand this waiver and release. I accept the terms voluntarily and grant permission for my child(ren) to participate fully in Treasured Talents Inclusive Summer Camp 2026.
Yes
52
Parent/Guardian Full Name:* This field is required.Name of parent completing the form for acknowledgement.
First and Last Name
Relationship to Camper
53
Date * This field is required.
Enter Today's Date
Month
Day
Year
54
Parent / Guardian Signature * This field is required.Draw your signature in the box above (when completed online via Jotform).
55
Thank you for registering! Treasured Talents Camp is built for children just like yours. Due to limited capacity (40 campers), submitting this form does not guarantee a spot. We carefully review each application to ensure every enrolled camper receives the support and attention they deserve. Families selected will be contacted directly to confirm their spot. We hope to welcome your child this summer.

Questions? Contact us at camp@yarastarfoundation.org | www.yarastarfoundation.org
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