Pineapple Village Summer Camp Application

Summer Camp Application

May 26 - July 31, 2026 | Monday - Friday: 9 AM - 3 PM | Cost: $350 per week + Activities Fees | Ages: 17 and up! | Camp spaces are available on a first-come, first-served basis. Reserve your spot by submitting the application and camp fee! For more information, email contactus@pineapplevillagellc.com Website: www.pineapplevillagellc.com
Camper's Name:

First NameLast Name
Birth date:

MonthDayYear
Date
Age:
School:
Grade:
Gender:
T-shirt Size:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Caretaker #1 Name:
Parent/Caretaker #1 Phone:

CellWork
Parent/Caretaker #2 Name:
Parent/Caretaker #2 Phone:

CellWork
Parent's Email:
example@example.com

Camper Profile: Preferences, Needs & Behaviors

Help us support your camper
What type of activities does your child enjoy most?
List any activities that your child does not enjoy or any fears we should be aware of:
How does your child tolerate and/or interact with other children?
Are you aware of any specific sensory needs that your child exhibits?
What types of rewards or reinforcers are motivating for your child?
Is your child toilet-trained?
What type of toileting schedule is your child on and how often are they taken?
How does your child indicate the need to go?
How does your child choose to communicate their wants/needs most often? Please the following choices that apply most to your child.
Does your child currently have a Behavioral Intervention Plan included in their IEP at school?
If your child has a behavior intervention plan (BIP), you will be asked to bring a copy of this plan to camp.
What specific behavioral needs does your child currently have right now?
What does the behavior look like? (Ex. biting hand, hitting head on hard surfaces, dropping to the floor, etc.):
When and how often does it seem to occur?
How long does the behavior usually last? (Ex. 5 minutes)?
What type of interventions or calming techniques have you found to be useful in dealing with these behaviors?

Summer Camp Application