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REGISTRATION
Camp Horizon 2022 Registration
Complete the form below to register for Camp Horizon 2022!
Step
1
of
5
20%
Contact Details
Camper Name
*
First
Last
Nickname
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
*
Please select
Male
Female
Date of Birth
*
MM slash DD slash YYYY
Current Age
*
Please enter a number from
0
to
20
.
T-Shirt Size
*
Please select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL
Grade in Fall 2022
*
Please select
K
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
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
None
Vegetarian
Vegan
Kosher
Gluten-free
Other
How Much Assistance Does Your Child Need to:
Get Dressed
None
Minimal Assistance
Medium Assistance
Maximum Assistance
Eat
None
Minimal Assistance
Medium Assistance
Maximum Assistance
Toilet
None
Minimal Assistance
Medium Assistance
Maximum Assistance
Swim
None
Minimal Assistance
Medium Assistance
Maximum Assistance
Mobilize Over Uneven Surface
None
Minimal Assistance
Medium Assistance
Maximum Assistance
List Any Flotation Devices You Are Providing
Additional Comments
Camper's Experience and Expectations
Temperament
Timid
Quiet
Aggressive
Sensitive
Average
Excitable
Other
If Other:
Known Fears and Weaknesses
Sleeping Habits
Eating Habits
Adjusts to New People:
Very Easily
Easily
With Difficulty
Participates in Group Activities
Easily
With Encouragement
With Difficulty
Suggestions on how to address camper's fears or encourage participation:
Camper's Attitude Towards Camp Experience:
Enthusiastic
Interested
Lukewarm
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
MM slash DD slash YYYY