*Application - Finding Balance Adult Program

Adult Day Camp APPLICATION

A Division of 3 Bluebirds Farm ( revised 06/2026)
Welcome to the Finding Balance application process.

We encourage the applicant to complete this application as independently as possible, as it helps us get to know their voice, interests, strengths, and goals directly. Support from a parent, guardian, or caregiver is welcome when needed; however, responses should reflect the applicant's own thoughts and perspective whenever possible.

Before continuing, please note that Finding Balance is a farm-based program located at 3 Bluebirds Farm. Participants regularly engage in outdoor activities, including animal care, gardening, nature-based learning, and other hands-on experiences. As a result, participants may be exposed to weather conditions, insects, animals, dirt, pollen, and other environmental allergens commonly found on a working farm.

Individuals with severe allergies, significant fears of animals, or a strong aversion to outdoor activities may find that the program is not the best fit for their needs.

Please note that submission of an application does not guarantee acceptance into Finding Balance. This is a review-based application process, and all applicants must meet the program's eligibility criteria and participate in an interview prior to acceptance.
Who is completing this application?

Other
Before selecting the sessions you're interested in, would you like to see a summary of the tuition & payment options?
Tuition

Standard Tuition
(Participants enrolling in one or two sessions)
- 2-Week Session: $950
- 3-Week Session: $1425
- 4-Week Session: $1,900
Pathway Tuition
(Participants enrolling in three or more sessions)
- 2-Week Session: $900
- 3-Week Session: $1350
- 4-Week Session: $1800
✔ Discounted tuition

✔ Eligible for Monthly Payment Plan

✔ Bluebird Badge & Milestone progression

✔ Structured year-long learning pathway

Payment Options

Pay Per Session
The remaining tuition balance for each registered session is automatically processed 14 days before the start of that session.

Monthly Payment Plan

Participants enrolling in three (3) or more sessions may divide their remaining annual tuition into seven equal automatic payments scheduled throughout the program year.
Which sessions are you interested in applying for?
1. Applicant Information
How did you hear about us?

Other
Applicant's Name:

First NameLast Name
Applicant's Preferred Name:
Applicant's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Applicant's Current Age:
Applicant's Cell Phone Number

Area CodePhone Number
Applicant's Email
example@example.com
Applicant's Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Living Arrangements:

Other
What pronouns do you go by?
Please upload a recent picture of yourself:

Browse Files
We use participant photos to help our team become familiar with applicants before interviews and program participation. This helps us provide a more welcoming and personalized experience. Photos are used internally only and are not shared publicly without separate permission. Cancelof
Are you (applicant) your own guardian?
2. Parent/Legal Guardian Information

If applicable
Name of applicant's parent or legal guardian/custodian (IF APPLICABLE):

First NameLast Name
Phone number of parent or legal guardian/custodian (if applicable):

Area CodePhone Number
Email of parent or legal guardian/custodian (if applicable):
example@example.com
Address of parent or legal guardian/custodian (if applicable):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
3. Responsible Party for Payment
Is the party responsible for payment the same as the legal guardian/custodian?
Name of the party responsible for payment

First NameLast Name
Phone Number of the party responsible for payment

Area CodePhone Number
Email of the party responsible for payment
example@example.com
Address of the party responsible for payment

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
4. Candidate Criteria to Attend Finding Balance

Diagnosis & Support Needs

Rows	YES
Does not require a 1:1 aide
Does not eat inedible objects (Pica)
Ability to participate in activities without disruptive behaviors that interrupt the event with no active aggression or risk of elopement.
Willingness & ability to participate in group activities that require conversational skills
Is able to follow verbal directions
Is able to verbalize wants and needs
Independence in all daily living skills (toileting, eating, dressing)
Ability to remain in open space without wandering or running
Applicant must have a documented diagnosis of Autism Spectrum Disorder (ASD)
Applicant is able to function with minimal support in a small group setting (1:4) ratio.

Age & Eligibility

Rows	YES
Is 18+ (high school exit or transition-age adults)
Able to self regulate with support and willing to participate in structured froup activities.
Applicant must be interested in building social, vocational, and life skills in a naturalistic setting.

Communication, Literacy & Participation

Rows	YES
Has basic receptive and expressive communication skills (verbal or supported)
Demonstrate the ability to write & spell for journaling, worksheets, and written components of the curriculum (independently or with support)
Shows a willingness to participate in group discussions and role playing, farm tasks (gardening and animal care), and activities such as games, crafts, or cooking, etc.

Curriculum Alignment

Rows	YES
Applicant is actively working on (or interested in working on) skills like..initiating conversations, maintaining friendships, handling teasing/conflict, and appropriate digital communication.
Able to engage with structured lessons and social coaching
Open to learning in a supportive, guided social environment that includes written reflection and behaviorial rehearsal

Physical & Environmental Fit

Rows	YES
Able to navigate outdoor spaces (farm terrain, garden beds, animal pens).
Tolerant of sensory inputs common on a working farm (smells, sounds, textures).
Independently able to manage basic personal hygiene and self-care

Comments?
Have you attended any 3 Bluebirds Farm activities before?
What are your your interests?
What are your strengths and talents at home and in the community?
What do you hope to achieve from the Adult Day Camps at 3BBF?
What causes stress for you?
How do you react when you are stressed? (for example, do you shut down, melt down, stem, etc).
What is the best way that we can help you when you are stressed?
What do you most admire about yourself?
If you had an hour of free time, how would you most likely use that time?
Are you shy, sensitive or nervous about anything we should be aware of?
What concerns (if any) do you have about participating in the Adult Day Camps?
Please write down anything else you'd like us to know about yourself to help make your involvement in the Adult Day Camps be a successful experience.
Do you have seizures of any kind? If yes, please let us know the type & frequency. (If none, type "none"):
Disabilities/Limitations besides autism (If none, type "none"):

Are there any unusual family circumstances that make Adult Day Camps especially important for you?

Rows	Often	Sometimes	Not At All
Hyperactive
Learning Disabilites
Nightmares
Sexually Acting Out
Steals
"Meltdowns"
Lying
Withdrawn

Please elaborate on any of these selections above or add anything else we may have missed:
5. Acknowledgment
APPLICANT: I certify that the information provided in this application is accurate and reflects my understanding and interest in participating in Finding Balance.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
(IF APPLICABLE) LEGAL GUARDIAN/CUSTODIAN: I certify that the information provided in this application is accurate to the best of my knowledge. I understand that submission of this application does not guarantee acceptance into Finding Balance and that additional registration materials and program agreements will be required if the applicant is accepted.
Relationship to Applicant
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Adult Day Camp APPLICATION

1. Applicant Information

2. Parent/Legal Guardian Information

3. Responsible Party for Payment

4. Candidate Criteria to Attend Finding Balance

5. Acknowledgment