(Please note that completing this form does not register your child for camp.)

Currently Registration is ONLY AVAILABLE for RETURNING CAMPERS

RETURNING CAMPER ONLY PRE-ONLINE REGISTRATION opens up on FEBRUARY 18th
NEW CAMPER PRE-ONLINE REGISTRATION-if space permits-opens up on March 25th
  
*Once the Online Pre-Registration Paperwork is complete you MUST attend a MANDTORY Registration Intake Date prior to the MANDTORY Registration Intake Date*

RETURNING CAMPERS ONLY REGISTRATION INTAKE: Saturday, March 16th 8:00-11:00 a.m.
RETURNING and NEW CAMPERS REGISTRATION INTAKE: Saturday, April 13th 8:00-11:00 am (if space permits)
RETURNING AND NEW CAMPERS REGISTRATION INTAKE: Monday, April 15th 5:00-7:00 pm (if space permits)

**You are not guaranteed a space until you have completed both the Pre-Online Registration and attended the Registration Intake Date.  SPACE IS LIMITED Registration is based on a first come, first serve basis.**
Once Space is filled you will be able to be placed onto our Waiting List

GENERAL INFORMATION
Child's Name *
Child's Name
Address *
Address
Date of Birth *
Date of Birth
Gender *
Please list all.
Please list all.
Primary Physician's Phone *
Primary Physician's Phone
Has your child attended Camp Ability in the past? *
Mother's Name
Mother's Name
Mother's Phone
Mother's Phone
Mother's Address
Mother's Address
Father's Name
Father's Name
Father's Phone
Father's Phone
Father's Address
Father's Address
I give permission for my contact to be registered with the REMIND APP for messages to be texted/emailed to me regarding Camp Ability. *
Please check ALL weeks you wish your child to attend. *
Based upon availability
Please check ALL hours you wish your child to attend. *
I consent to and authorize the use and reproduction by Special Kids of any and all photographs/audio/visual materials taken of my child for promotional material, educational activities, and/or for any other use for the benefit of the program. *
MEDICAL & BEHAVIORAL INFORMATION
Does your child have seizures? *
If yes, what was the date of your child's last seizure?
If yes, what was the date of your child's last seizure?
Does your child have a feeding tube? *
Does your child need assistance with feeding? *
Does your child use any type of assistive device? *
Does your child require assistance in transfers? *
Is your child toilet trained? *
Does your child need assistance with toileting? *
Is your child verbal? *
Is your child able to follow 2 to 3 step directions? *
Does your child know how to swim? *
Has your child ever displayed aggressive behaviors towards his or herself? *
Has your child ever displayed aggressive behaviors towards others? *
ABOUT YOUR CHILD
The more information we have, the better we will be able to care for your child.
EMERGENCY CONTACT
I give permission for my child to be transported by the Emergency Contacts included below if I am unable to be reached. *
Today's Date *
Today's Date
Emergency Contact #1 *
Emergency Contact #1
Emergency Contact #1 Phone *
Emergency Contact #1 Phone
Emergency Contact #2 *
Emergency Contact #2
Emergency Contact #2 Phone *
Emergency Contact #2 Phone
Emergency Contact #3
Emergency Contact #3
Emergency Contact #3 Phone
Emergency Contact #3 Phone