Inclusive Summer Camp Registration Form (Ages 5-11)

Inclusive Summer Camp Registration Form (Ages 5-11)

Thank you for your interest in our summer camp program. Please complete this form to help us determine fit, support needs, and programming considerations for your child. Submission of this form does not guarantee placement. Families will be contacted to confirm registration, availability, and any additional support requirements.
Program Selection
Which week(s) are you registering for?*

July 6-10July 13-17Both weeks
Attendance Option*

Half Day (10am-12pm)Full Day (10am-3pm)
Child Information
Child name*

First NameMiddle NameLast Name
Date of birth*

MonthDayYear
Date
Age
School
Grade (2025-26 school year)
Parent or guardian name*

First NameMiddle NameLast Name
Phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Email address*
example@example.com
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency contact name*

First NameLast NamePhone Number
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child*
Funding and Support
Funding Type*

Private PayAutism Funding
Does your child currently receive any of the following supports?

Behaviour ConsultantSpeech-Language PathologistOccupational TherapistCounsellor/PsychologistSupport WorkerSchool-based supportNone currentlyOther
Communication
How does your child usually communicate?*

Speaks in full sentencesUses short phrasesUses single wordsUses gestures/facial expressionsUses pictures/communication aidsOther
How does your child typically communicate?

Spoken languageShort phrasesFull sentencesAAC deviceVisual supportsGesturesSignsOther
Please describe how your child communicates their wants and needs
How does your child let adults know when they need help, a break, or are feeling upset?
Are there any communication strategies that work especially well with your child?
What kinds of activities does your child especially enjoy?

Arts and craftsOutdoor playMinecraft/gamingCookingSwimming/water playBoard gamesBuilding/constructionSensory playImaginative playSports/movementNature walks/park
Social, Play, and Interests
Please tell us about your child’s interests, strengths, and favourite activities
How does your child typically do in a small-group setting?

Very comfortableUsually does well with some supportMay take time to warm upOften finds groups difficult
Are there any social situations that are especially hard for your child?
Regulation, Behaviour, and Safety
Are there any behaviours or support needs we should know about to help your child be successful and safe at camp?
Does your child ever engage in any of the following when upset, overwhelmed, or dysregulated?

Running/elopingHitting/kickingThrowing itemsVerbal aggressionProperty destructionSelf-injuryRefusal/shutdownBolting in community settingsOther
If yes, please describe what these situations can look like and what tends to help
Are there known triggers or situations that may lead to distress or dysregulation? Examples: waiting, losing games, transitions, changes in routine, noise, denied access, peer conflict
What strategies are most helpful when your child is upset or overwhelmed?
Are there any safety concerns we should be aware of during community outings?

NoYes
If yes, please describe
Does your child require individualized 1:1 support in order to participate successfully and safely in a camp setting? Note: Our ratio is 4 kids to 1 adult.

NoUnsureYes
If yes or unsure, please describe the level of support your child typically needs
Has your child previously attended camp, school, or community programs with 1:1 support?

NoYes
What helps your child participate most successfully in a group program?
Please note: A limited number of 1:1 support spaces may be available at an additional cost of $15/hour, subject to staffing availability.
Health and Personal Care
Does your child have any medical information, allergies, dietary needs, or health concerns we should know about?
Does your child require support with toileting or personal care?

NoYes, in diapers/pull upsYes, requires reminders and assistance
Is your child able to participate in swimming and community outings with staff support?

YesNoUnsure
Are there any sensory needs or sensitivities we should be aware of? Examples: noise, touch, clothing, smells, busy spaces, transitions
Goals
44. What are your main goals for your child in attending camp? Check all that apply:

Fun and enjoymentSocial opportunitiesTrying new activitiesBuilding independenceCommunity participationRegulation/supportive environmentMaking friends
Consent and Acknowledgement
Parent / Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Confirmations*

I confirm that the information provided above is accurate to the best of my knowledge.I understand that submission of this form does not guarantee placement and that registration is subject to availability and program fit.I understand that if my child requires specialized 1:1 support, this will be discussed with me and may involve additional fees.
Should be Empty:

Inclusive Summer Camp Registration Form (Ages 5-11)

Program Selection

Child Information

Funding and Support

Communication

Social, Play, and Interests

Regulation, Behaviour, and Safety

Health and Personal Care

Goals

Consent and Acknowledgement