Application for Special Needs Programming

We are now accepting applications for our 2025 Art Workshops and Art & Music Camp!

Art Workshops for 2025

DATES

To be determined.

TIMES

To be determined.

Art & Music Camp for 2025

DATES

June 2 – June 6

July 14 – July 18

TIMES

10:00 am – 12:00 pm (Ages 5-13)

1:00 pm – 3:00 pm (Ages 14 - Adult)

10:00 am – 12:00 pm (Ages 14 - Adult)

1:00 pm – 3:00 pm (Ages 14 - Adult)

Which dates are you interested in?*

Select all that apply.

I'm interested in Workshops – keep me updated!

Summer Camp: June 2-6 - 10am to 12pm (Ages 5-13)

Summer Camp: June 2-6 - 1pm to 3pm (Ages 14 - Adult)

Summer Camp: July 14 -18 - 10am to 12pm (Ages 14 - Adult)

Summer Camp: July 14 -18 - 1pm to 3pm (Ages 14 - Adult)

Social Adjustment

This information helps us understand how to best support your Participant during camp.

Social Interactions

How does your Participant get along at home, at school, and with peers?*

Have there been any behavioral challenges at home, at school, or with peers?*

Do you feel your Participant could adjust to working in a group setting for one week without any major problems? If "No," please explain*

Has your Participant attended any camp(s) before?*

Yes

No

Triggers and Positive Experiences

Is there anything that triggers a negative reaction in your Participant?*

Is there anything we should know that would help make camp a positive experience for your Participant?*

Goals and Additional Information

What do you or your Participant hope to get out of this special needs program?*

Any additional information you would like to share about your Participant?*

Parent/Guardian Information

Full Name*

Street Address*

City*

State*

Zip Code*

Country*

Home Phone Number*

Cell Phone Number*

Please give us alternative phone numbers, as we may need more than one way to contact you while your Participant is with us.

Work Phone Number (optional)

Email Address*

Will you or an aide be accompanying your Participant for the week?*

Yes

No

If an aide will attend, please provide their name and cell phone number:

Emergency Contact Information

Emergency Contact Name*

Relationship to Camper*

Emergency Contact Phone Number 1*

Emergency Contact Phone Number 2*

Pick-Up Authorization

Name(s) of individuals allowed to pick up the Participant:*

Art Workshops for 2025

Art & Music Camp for 2025

Participant Information

Medical Information

Participant's Healthcare Information

Diagnosis and Medical History

Seizures and Communicable Diseases

Personal Care Needs

Allergies and Medications

Special Equipment and Activity Limitations

Social Adjustment

Social Interactions

Triggers and Positive Experiences

Goals and Additional Information

Parent/Guardian Information

Emergency Contact Information

Pick-Up Authorization

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