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Encouraging
Awareness and Acceptance of Autism
one step at a time
2025 Summer Camp Registration
Participant First Name:
*
Participant Last Name:
*
Participant Birthday:
*
Month
Participant Preferred Color:
*
Participant Preferred Snacks and Drinks:
*
Participant Preferred Activities/Interests:
*
Participant Sensory Triggers (if any):
*
Participant Allergies:
*
Participant Medical Conditions or Disabilities:
*
Participant Physical Restrictions (if applicable):
*
Participant Preferred Method of Behavioral Support:
*
Strategies for Supporting Participant:
*
Participant Preferred Method of Communication:
*
Verbal
Non-Verbal
Sign Language
Picture (PECS)
Speech Device
Other
If "Other" is selected, please describe:
Participant Assistance Needed (check all that apply):
*
Mobility Assistance
Feeding Assistance
Personal Care (toileting, etc.)
Medication
Other
If "Other" is selected, please describe:
Participant Support Staff Needed:
*
1:1 Support
Small Group Support
No Support Needed
Other
If "Other" is selected, please describe:
Please provide any other relevant information about your child’s needs or preferences that will help the camp staff provide the best care and experience for your child:
*
Primary Emergency Contact Name:
*
Primary Emergency Contact Phone Number:
*
Secondary Emergency Contact Name:
*
Secondary Emergency Contact Phone:
*
Authorized Pick-up Person: Name and Phone Number
*
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