Camp PARC · Camper Application

Camper Application

Are you applying for a

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Applicant Name

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First Name

Last Name

Is the applicant ambulatory?

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Camper must be able to walk without assistive devices.

Yes

No

We are sorry but due to the natural terrain of the campsite, Camp PARC is unable to accommodate wheelchairs (manual or power), electric scooters, or other mobility devices. If you wish to speak to our directors, please contact Ted or Judy Risch at 814-410-5343.

Is the applicant continent?

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Camper must be toilet trained.

Yes

No

We are sorry but Camp PARC is unable to accommodate the needs of your camper. If you wish to speak to our directors, please contact Ted or Judy Risch at 814-410-5343.

Is the applicant combative or physically aggressive?

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Camper must not bite, hit, or physically harm self or others.

Yes

No

We are sorry but Camp PARC is unable to accommodate the needs of your camper. If you wish to speak to our directors, please contact Ted or Judy Risch at 814-410-5343.

Applicant Age

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Does the applicant want to participate in Camp PARC 2023?

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Yes

No

Has there been any changes to the applicant's mobility since they last attended Camp PARC?

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Yes

No

Please describe

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Best time to reach you for a brief discussion regarding the participant's health changes

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Thank you for updating us regarding your applicant's health. We love having our campers return year after year! However, sometimes health and/or mobility changes may require a change in participation at Camp PARC. This brief phone call with our directors will ensure that Camp PARC is still an appropriate setting for the applicant and will enable us to place the camper in the session that will best meet their needs.

Morning (9am - 11am)

Over Lunch (11:30 am - 1 pm)

Afternoon (2 pm - 4 pm)

Evening (6 pm - 8 pm)

Parent/Guardian Name

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First Name

Last Name

Phone Number

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What number can we reach you for a brief call

Has the applicant remained continent?

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Yes

No

Please describe

Best time to reach you for a brief discussion regarding the participant's health changes

*

Thank you for updating us regarding your applicant's health. We love having our campers return year after year! However, sometimes health and/or mobility changes may require a change in participation at Camp PARC. This brief phone call with our directors will ensure that Camp PARC is still an appropriate setting for the applicant and will enable us to place the camper in the session that will best meet their needs.

Morning (9am - 11am)

Over Lunch (11:30 am - 1 pm)

Afternoon (2 pm - 4 pm)

Evening (6 pm - 8 pm)

Parent/Guardian Name

*

First Name

Last Name

Phone Number

*

What number can we reach you for a brief call

Have there been any incidents of physical aggression or combative behavior since the applicant last attended Camp PARC?

*

Yes

No

Please describe

Best time to reach you for a brief discussion regarding the participant's health changes

*

Thank you for updating us regarding your applicant's health. We love having our campers return year after year! However, sometimes health and/or mobility changes may require a change in participation at Camp PARC. This brief phone call with our directors will ensure that Camp PARC is still an appropriate setting for the applicant and will enable us to place the camper in the session that will best meet their needs.

Morning (9am - 11am)

Over Lunch (11:30 am - 1 pm)

Afternoon (2 pm - 4 pm)

Evening (6 pm - 8 pm)

Parent/Guardian Name

*

First Name

Last Name

Phone Number

*

What number can we reach you for a brief call

Has there been any other health related incidents or changes since the applicant has attended Camp PARC that may alter their participation level?

*

Yes

No

Briefly describe

*

Best time to reach you for a brief discussion regarding the participant's health changes

*

Thank you for updating us regarding your applicant's health. We love having our campers return year after year! However, sometimes health and/or mobility changes may require a change in participation at Camp PARC. This brief phone call with our directors will ensure that Camp PARC is still an appropriate setting for the applicant and will enable us to place the camper in the session that will best meet their needs.

Morning (9am - 11am)

Over Lunch (11:30 am - 1 pm)

Afternoon (2 pm - 4 pm)

Evening (6 pm - 8 pm)

Parent/Guardian Name

*

First Name

Last Name

Phone Number

*

What number can we reach you for a brief call

Parent/Guardian Information

Parent/Guardian Name

*

First Name

Last Name

Send Registration Forms to this Email Address:

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Verify Email

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Parent/Guardian Email

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Verify Email

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Preferred Phone Number

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Preferred Phone Number

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Address

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Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Best time to reach you for a brief intake assessment

It is required that all new participants complete a brief intake assessment over the phone prior to attending Camp PARC. This will ensure that Camp PARC is an appropriate setting for the applicant and will enable our staff to place the potential camper in the session that will best meet their needs.

Morning (9am - 11am)

Over Lunch (11:30 am - 1 pm)

Afternoon (2 pm - 4 pm)

Evening (6 pm - 8 pm)

How did you hear about Camp PARC?

*