Kids Camp Survey

Kids Camp Survey

We are excited that your child(ren) will be joining the Kids Camp this summer at the CCDS Symposium. Please take a few minutes to complete this survey so that we can be prepared to give your child(ren) the care and accommodations they require and provide the best experience possible.
Parent/Guardian Contact
Name of Parent/Guardian 1 Completing this Form*

First NameLast Name
Parent/Guardian 1 cell phone number*
Please enter a valid phone number; we will use this to contact you during Kids Camp if necessary.Format: (000) 000-0000.
Name of Parent/Guardian 2 attending symposium (if applicable)

First NameLast Name
Parent/Guardian 2 cell phone number
Please enter a valid phone number; we will use this to contact you during Kids Camp if necessary.Format: (000) 000-0000.
How many children from your family will be attending the Kids Camp?*
Participant & Session Details
- Camper’s Full Name*
  
  First NameLast Name
- Camper’s Age (in June 2026)*
- Please upload a headshot of your child. This will help our staff to put names and faces together before the camp!*
  
  Cancelof
- Sessions Camper will attend*
  
  Thursday June 25, 2-5pmFriday June 26, 8:30am-5pmSaturday June 27, 8:30am-5pm
- Which best describes this camper?*
  
  Affected by a CCDS; requires some level of additional supportRequires no additional support beyond the usual needs for their age
- What level of support do you feel the camper will need to have a positive experience?*
  
  One-on-one support from the camp staffWe are sending a support person to attend camp with themA group of 2-3 campers is a good fitA group of 3-4 campers would be comfortableNo direct support will be needed
- What is the name of the support person?*
- What is the cell phone number of the support person?*
  Please enter a valid phone number.Format: (000) 000-0000.
- Do we have permission to release your child from camp, in this person's care?*
  
  YesNo
- There will be a bus picking up kids (and their assigned buddy(s)) to go to the National Ability Center either first thing in the morning or at about noon. You can learn more about the NAC at discovernac.org. They are an incredible all-abilities outdoor recreation camp that is a 20 minute ride from the hotel located in Park City next to the Park City Hospital. NAC is staffed by trained OT and PT professionals and they ran a great camp for our kids in 2022. Would you like your child to attend a half day at NAC on Friday and Saturday? (If you choose yes, we will share your contact information with NAC so they can contact you to complete their waiver.) We are asking for your preference of AM or PM for NAC and will do our best to accommodate but cannot guarantee the schedule.*
  
  Yes, we could do AM or PMYes, we prefer AMYes, we prefer PMNo, please keep them at the hotel
- Children 14 or older that do not require direct support, often ask to leave the camp for various reasons. Does this child have permission to leave the hotel kids camp whenever they choose? (They will not be allowed to leave the NAC.)*
  
  Yes; they can come and go as they please.No; please do not allow them to leave without a parent checking them out.
- Does this child have dietary restrictions or allergies?*
  
  YesNo
- Please describe the dietary restrictions or allergies*
- Will this child be bringing any supplements or medications to camp? *Please note that we can only administer over-the-counter supplements for CCDS and emergency seizure medications. Please plan to give all other prescription medications to your child. If your child goes to the National Ability Center (NAC), they will either be gone from 9am-1:00pm or 12-4:00pm. Lunch will be eaten at the NAC. Please plan medications accordingly.*
  
  YesNo
- Please list the OTC supplements or emergency seizure medications, when they are to be given, in what dosage, and any other important information. These must be clearly labeled with your child's name.*
- If your child has things that upset them and/or behaviors the camp staff should be prepared for, will you please describe how they present and the best ways to help your child through these? Please describe in detail. Additionally, please let us know if you'd like to arrange a Zoom call to talk more about this with the camp director, Jessica Harmon.*
- What size t-shirt does this camper wear?*
  
  Youth 2TYouth 3T/4TYouth 5TYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult 2XL
- Camper’s Full Name*
  
  First NameLast Name
- Camper’s Age (in June 2026)*
- Please upload a headshot of your child. This will help our staff to put names and faces together before the camp!*
  
  Cancelof
- Sessions Camper will attend*
  
  Thursday June 25, 2-5pmFriday June 26, 8:30am-5pmSaturday June 27, 8:30am-5pm
- Which best describes this camper?*
  
  Affected by a CCDS; requires some level of additional supportRequires no additional support beyond the usual needs for their age
- What level of support do you feel the camper will need to have a positive experience?*
  
  One-on-one support from the camp staffWe are sending a support person to attend camp with themA group of 2-3 campers is a good fitA group of 3-4 campers would be comfortableNo direct support will be needed
- What is the name of the support person?*
- What is the cell phone number of the support person?*
  Please enter a valid phone number.Format: (000) 000-0000.
- Do we have permission to release your child from camp, in this person's care?*
  
  YesNo
- There will be a bus picking up kids (and their assigned buddy(s)) to go to the National Ability Center either first thing in the morning or at about noon. You can learn more about the NAC at discovernac.org. They are an incredible all-abilities outdoor recreation camp that is a 20 minute ride from the hotel located in Park City next to the Park City Hospital. NAC is staffed by trained OT and PT professionals and they ran a great camp for our kids in 2022. Would you like your child to attend a half day at NAC on Friday and Saturday? (If you choose yes, we will share your contact information with NAC so they can contact you to complete their waiver.) We are asking for your preference of AM or PM for NAC and will do our best to accommodate but cannot guarantee the schedule.*
  
  Yes, we could do AM or PMYes, we prefer AMYes, we prefer PMNo, please keep them at the hotel
- Children 14 or older that do not require direct support, may ask to leave the camp for various reasons. Does this child have permission to leave the hotel kids camp whenever they choose? (They will not be allowed to leave the NAC.)*
  
  Yes; they can come and go as they please.No; please do not allow them to leave without a parent checking them out.
- Does this child have dietary restrictions or allergies?*
  
  YesNo
- Please describe the dietary restrictions or allergies*
- Will this child be bringing any supplements or medications to camp? *Please note that we can only administer over-the-counter supplements for CCDS and emergency seizure medications. Please plan to give all other prescription medications to your child. If your child goes to the National Ability Center (NAC), they will either be gone from 9am-1:00pm or 12-4:00pm. Lunch will be eaten at the NAC. Please plan medications accordingly.*
  
  YesNo
- Please list the OTC supplements or emergency seizure medications, when they are to be given, in what dosage, and any other important information. These must be clearly labeled with your child's name.*
- If your child has things that upset them and/or behaviors the camp staff should be prepared for, will you please describe how they present and the best ways to help your child through these? Please describe in detail. Additionally, please let us know if you'd like to arrange a Zoom call to talk more about this with the camp director, Jessica Harmon.*
- What size t-shirt does this camper wear?*
  
  Youth 2TYouth 3T/4TYouth 5TYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult 2XL
- Camper’s Full Name*
  
  First NameLast Name
- Camper’s Age (in June 2026)*
- Please upload a headshot of your child. This will help our staff to put names and faces together before the camp!*
  
  Cancelof
- Sessions Camper will attend*
  
  Thursday June 25, 2-5pmFriday June 26, 8:30am-5pmSaturday June 27, 8:30am-5pm
- Which best describes this camper?*
  
  Affected by a CCDS; requires some level of additional supportRequires no additional support beyond the usual needs for their age
- What level of support do you feel the camper will need to have a positive experience?*
  
  One-on-one support from the camp staffWe are sending a support person to attend camp with themA group of 2-3 campers is a good fitA group of 3-4 campers would be comfortableNo direct support will be needed
- What is the name of the support person?*
- What is the cell phone number of the support person?*
  Please enter a valid phone number.Format: (000) 000-0000.
- Do we have permission to release your child from camp, in this person's care?*
  
  YesNo
- There will be a bus picking up kids (and their assigned buddy(s)) to go to the National Ability Center either first thing in the morning or at about noon. You can learn more about the NAC at discovernac.org. They are an incredible all-abilities outdoor recreation camp that is a 20 minute ride from the hotel located in Park City next to the Park City Hospital. NAC is staffed by trained OT and PT professionals and they ran a great camp for our kids in 2022. Would you like your child to attend a half day at NAC on Friday and Saturday? (If you choose yes, we will share your contact information with NAC so they can contact you to complete their waiver.) We are asking for your preference of AM or PM for NAC and will do our best to accommodate but cannot guarantee the schedule.*
  
  Yes, we could do AM or PMYes, we prefer AMYes, we prefer PMNo, please keep them at the hotel
- Children 14 or older that do not require direct support, may ask to leave the camp for various reasons. Does this child have permission to leave the hotel kids camp whenever they choose? (They will not be allowed to leave the NAC.)*
  
  Yes; they can come and go as they please.No; please do not allow them to leave without a parent checking them out.
- Does this child have dietary restrictions or allergies?*
  
  YesNo
- Please describe the dietary restrictions or allergies*
- Will this child be bringing any supplements or medications to camp? *Please note that we can only administer over-the-counter supplements for CCDS and emergency seizure medications. Please plan to give all other prescription medications to your child. If your child goes to the National Ability Center (NAC), they will either be gone from 9am-1:00pm or 12-4:00pm. Lunch will be eaten at the NAC. Please plan medications accordingly.*
  
  YesNo
- Please list the OTC supplements or emergency seizure medications, when they are to be given, in what dosage, and any other important information. These must be clearly labeled with your child's name.*
- If your child has things that upset them and/or behaviors the camp staff should be prepared for, will you please describe how they present and the best ways to help your child through these? Please describe in detail. Additionally, please let us know if you'd like to arrange a Zoom call to talk more about this with the camp director, Jessica Harmon.*
- What size t-shirt does this camper wear?*
  
  Youth 2TYouth 3T/4TYouth 5TYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult 2XL
- Camper’s Full Name*
  
  First NameLast Name
- Camper’s Age (in June 2026)*
- Please upload a headshot of your child. This will help our staff to put names and faces together before the camp!*
  
  Cancelof
- Sessions Camper will attend*
  
  Thursday June 25, 2-5pmFriday June 26, 8:30am-5pmSaturday June 27, 8:30am-5pm
- Which best describes this camper?*
  
  Affected by a CCDS; requires some level of additional supportRequires no additional support beyond the usual needs for their age
- What level of support do you feel the camper will need to have a positive experience?*
  
  One-on-one support from the camp staffWe are sending a support person to attend camp with themA group of 2-3 campers is a good fitA group of 3-4 campers would be comfortableNo direct support will be needed
- What is the name of the support person?*
- What is the cell phone number of the support person?*
  Please enter a valid phone number.Format: (000) 000-0000.
- Do we have permission to release your child from camp, in this person's care?*
  
  YesNo
- There will be a bus picking up kids (and their assigned buddy(s)) to go to the National Ability Center either first thing in the morning or at about noon. You can learn more about the NAC at discovernac.org. They are an incredible all-abilities outdoor recreation camp that is a 20 minute ride from the hotel located in Park City next to the Park City Hospital. NAC is staffed by trained OT and PT professionals and they ran a great camp for our kids in 2022. Would you like your child to attend a half day at NAC on Friday and Saturday? (If you choose yes, we will share your contact information with NAC so they can contact you to complete their waiver.) We are asking for your preference of AM or PM for NAC and will do our best to accommodate but cannot guarantee the schedule.*
  
  Yes, we could do AM or PMYes, we prefer AMYes, we prefer PMNo, please keep them at the hotel
- Children 14 or older that do not require direct support, may ask to leave the camp for various reasons. Does this child have permission to leave the hotel kids camp whenever they choose? (They will not be allowed to leave the NAC.)*
  
  Yes; they can come and go as they please.No; please do not allow them to leave without a parent checking them out.
- Does this child have dietary restrictions or allergies?*
  
  YesNo
- Please describe the dietary restrictions or allergies*
- Will this child be bringing any supplements or medications to camp? *Please note that we can only administer over-the-counter supplements for CCDS and emergency seizure medications. Please plan to give all other prescription medications to your child. If your child goes to the National Ability Center (NAC), they will either be gone from 9am-1:00pm or 12-4:00pm. Lunch will be eaten at the NAC. Please plan medications accordingly.*
  
  YesNo
- Please list the OTC supplements or emergency seizure medications, when they are to be given, in what dosage, and any other important information. These must be clearly labeled with your child's name.*
- If your child has things that upset them and/or behaviors the camp staff should be prepared for, will you please describe how they present and the best ways to help your child through these? Please describe in detail. Additionally, please let us know if you'd like to arrange a Zoom call to talk more about this with the camp director, Jessica Harmon.*
- What size t-shirt does this camper wear?*
  
  Youth 2TYouth 3T/4TYouth 5TYouth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLAdult 2XL
- Liability Waiver*
  In consideration of the risk of injury that exists while participating in the Association for Creatine Deficiencies Kids Camp (hereinafter the "Activity"); and in consideration of my desire to participate in said Activity and being given the right to participate in same; I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives (hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in the Activity. I am voluntarily participating in the Activity and I am participating in the Activity entirely at my own risk. I am aware of the risks associated with participating in this Activity, which may include, but are not limited to: physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others'.
- I have read and agree to the Waiver and Release of Liability above.*
  
  Yes
- We're excited to see you at the symposium. Do you have any additional questions for us? *
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Kids Camp Survey

Parent/Guardian Contact

Participant & Session Details