Registration – Camp Horizon

Step 1 of 5

Contact Details

Camper Name*

First Last

Nickname

Primary Parent/Guardian Name

First Last

Home Address

Street Address City State Zip Code

Primary Parent/Guardian Email

Enter Email Confirm Email

Parent/Guardian Phone Number

Check if Trailblazer arriving on Friday Night (14 Years or Older Only)

Trailblazer Arriving Friday Night

Demographic Information

Gender*

Date of Birth*

Current Age*

Please enter a number from 0 to 20.

T-Shirt Size*

Grade in Fall 2022*

Medical Information

Medical Diagnosis and Pertinent Past Medical History

Physical Abilities and Limitations

How does your child communicate his/her basic needs?

Primary Means of Mobility (i.e. walking, wheelchair, walker, etc)

List any assistive devices your child will have to help mobilize on uneven terrain:

List any allergies your child has

Dietary Restrictions

How Much Assistance Does Your Child Need to:

Get Dressed

Eat

Toilet

Swim

Mobilize Over Uneven Surface

List Any Flotation Devices You Are Providing

Additional Comments

Camper's Experience and Expectations

Temperament

If Other:

Known Fears and Weaknesses

Sleeping Habits

Eating Habits

Adjusts to New People:

Participates in Group Activities

Suggestions on how to address camper's fears or encourage participation:

Camper's Attitude Towards Camp Experience:

Other Camp Experiences

Other Experiences Away from Home

Anything Else You Would Like to Share

Consent*

My child has permission to participate in Camp Horizon 2022

Typed Name*

Today's Date

Camp Horizon 2022 Registration

Contact Details

Demographic Information

Medical Information

How Much Assistance Does Your Child Need to:

Camper's Experience and Expectations