Embracing Abilities: 2026 Teacher Consent Form
Note to Teacher: The following information is extremely important in helping Embracing Abilities staff determine the best placement for the student at Summer Camp. Please be specific so we can provide the best experience possible for your student.
Camper's Name
*
First Name
Last Name
Camper's School
*
Teacher's Name
*
First Name
Last Name
Teacher's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Teacher's Email
*
Confirmation Email
example@example.com
Teacher Consent Form Questions
Please answer the questions below to the best of your ability
What age does the camper currently function at?
*
e.g. 5 years old
What age does the camper function within a social context?
*
e.g 5 years old
Is the camper in a special education class? If so, what type?
*
Please describe camper's receptive communication ability.
*
Please describe camper’s expressive communication ability.
*
Please explain specific behavioral difficulties and successful management techniques, if any.
*
What level of personal care does camper receive at school (mobility, feeding, toileting, number of people required to assist, etc.)?
*
Does the camper exhibit aggression in the school setting?
*
Yes
No
If you answered yes to the previous question, please explain:
*
Does the camper have a 1:1 aide in the classroom?
*
Yes
No
If you answered yes to the previous question, what is the aide’s focus (e.g. academic support, physical assistance, behavioral support)?
*
To best support the camper in an accessible community/environment, what staff-to-child ratio would you suggest?
*
1:1
1:3
1:4
Please explain your selection for the previous question:
*
Please describe the campers strengths and academic goals:
*
Teacher Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: