CAMP SAINT JOHN 2023 Camper Registration

WELCOME TO CAMP SAINT JOHN!

To register your child, complete the Camp Participant Form, below. After we review the application, we will contact you by email about your camper's status. We have a limited number of spots, so you may be placed on a waitlist.

Before completing this form, please review the CAMP GUIDELINES here: https://fs27.formsite.com/all4autism/images/Camp_Guidelines_-_2023.pdf

Deadline for registration form and fee is JUNE 21, 2023 at noon.

CAMPER INFORMATION:

First Name *

Last Name *

Camp Saint John is an inclusion-based camp designed for children diagnosed with autism (or other developmental disabilities), and their neurotypical peers. Please indicate below if your child has a diagnosed disability, or is Neurotypical. *

If you answered OTHER, please indicate your child's diagnosed disability:

If your child has a diagnosed disability, you will need to provide documentation for our review. Please attach one of the following: Letter of Eligibility from DDSN, a letter from a pediatrician/psychologist/specialist or most recent copy of an IEP/504. We will need this information before approving the camper's registration. If you prefer, you may also email the documentation to camp@all4autism.org.

Gender: *

Birth Date - Camp is open to participants 4 to 17 years of age.
(If entering manually, use MM-DD-YYYY format.) * +

Name of school child attended during 2022-23: *

Grade for 2022-23 school year *

Does the child require a paraprofessional (one-on-one assistance) at school? *

Street Address *

Address Line 2

City *

State *

Zip Code *

Has your child attended an All 4 Autism camp before? *

T-shirt Size *

Household / Adult Primary Contact

Relationship to Participant: *

Mother

Father

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Daytime Phone *

Alternate Phone

Email Address *

Has your child ever attended any type of camp before? *

Does your child have any allergies? If yes, please list and detail all allergies: *

What are your child's favorite activities? *

What tends to upset or frighten your child? Any phobias? *

What does your child do when he/she becomes upset? *

Is your child verbally aggressive or destructive at times? If so, please describe the circumstances: *

How does your child react to changes in his or her environment? *

Does your child have a history of physical aggression or self-injurious behavior? If so, please describe circumstances, frequency and how long since you have seen this behavior. *

Goals of camp experience: *

Does your child have any health, hygiene, or dietary issues? If yes, please give details: *

Does your child have a tendency to wander? (Please be aware that if your child has a tendency to wander or run away, he or she must attend with a guardian or adult caregiver.) *

If you answered "YES" to the question above, provide contact information for adult attending with child:

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Is your child toilet trained? (Please be aware that if your child is not toilet trained, he or she must attend with a guardian or adult caregiver.) *

If you answered "NO" to the question above, provide contact information for adult attending with child:

First Name

Last Name

Street Address

Address Line 2

City

State

Zip Code

Phone Number

Is your child currently receiving any services? If yes, list below:

Best number to reach you during camp hours:

Phone Number *

Name of person picking child up each day:

First Name *

Last Name *

Phone Number *

Any additional information you would like for us to know:

Camp Registration Fee - $25 *

$25.00

Waiver of Liability: In consideration of my child's registration being accepted, I waive any and all claims for myself, my administrators, and my heirs against all officials, sponsors, and organizations (including All 4 Autism, Trinity Evangelical Presbyterian Church and The Kings Academy) connected with Camp Saint John for injury or illness that may directly or indirectly result from my participation, or my child's participation in this event. I attest that I have full knowledge of the risks involved in this event, and my child, and myself are physically fit and sufficiently able to participate in this event.

Photo Release: All 4 Autism and its authorized representatives have my permission to record on photography film and/or video, pictures of my child or myself. I further agree that any or all of the material photographed may be used, in any form, as part of any future publications, brochure, or other printed materials used to promote All 4 Autism, and further that such use shall be without payment of fees, royalties, special credit or other compensation. *

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After reviewing your registration, we will contact all new campers to schedule a meet and greet at our resource center at least one week prior to camp.

Contact Information:

Dr. Abbey Brown, Camp Director

camp@all4autism.org

www.all4autism.org

843-472-5215