mph camper registration packet basic camper information · mph camper registration packet page 1...
TRANSCRIPT
MPH Camper Registration Packet
Page 1 Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
Name Phone Number Name Phone Number
Name Phone Number
Roommate Requests (we try to honor, no guarantee): 1) _________________ 2) _________________ 3) __________________
The people listed below may drop off/pick up camper. *Please contact the office if this information changes.*
1) ___________________________ (_____)_____-_____________ 2) ___________________________ (_____)_____-_____________
Accompanied by Caregiver? Contact office if changes. Yes No ____________________ (_____)_____-_____________
Check T-Shirt size: Youth S M OR Adult S M L XL 2XL 3XL 4XL 5XL Other: _________
Date: __________________________ MM / DD / YYYY
Last First Middle
MM / DD / YYYY
Camper Name: ___________________________________________________________ Nickname: ____________________________
Male Female Camper legally known as: ___________________________________________________________________
New Camper Returning Camper Date of Birth: ______________________ Age: ___________
BASIC CAMPER INFORMATION
Primary Disability: _____________________________________ Secondary Disability: _____________________________________
Camper requires one-on-one assistance: Yes No If yes, please explain: ________________________________________
Camper E-Mail, if any: __________________________________________ Camper phone, if any: (_______)________-____________
Referral Source: Advertisement Camp Resource Fair Word of Mouth Friends School Internet Sibling
Whom do we thank for the referral? ___________________________________________________________________________________
OPTIONAL Camper is from which one of the following ethnic groups (please check most predominant ethnic group):
African American, Black Native Hawaiian or other Pacific Islander Hispanic, Latino
Asian American Indian/Alaskan White, not Hispanic
Name home work cell home work cell
Name home work cell home work cell
Camper is own guardian Name/s of camper’s guardian/s, if not camper: _____________________________________
_________________________ (_____)_____-_____________ (_____)_____-_____________ E-Mail of guardian: ____________________
_________________________ (_____)_____-_____________ (_____)_____-_____________ E-Mail of guardian: ____________________
Camper’s address: _________________________________________________________________________________________________________
Camper lives in a group home or is with agency : __________________ Camper lives which OK county: ______________
First Last
First Last
home mobile work home mobile work
home mobile work home mobile work
text OK?
Page 2
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
CONTACT INFORMATION - emergency and non-emergency
home mobile work home mobile work
home mobile work home mobile work
home mobile work home mobile work
home mobile work home mobile work
City State Zip Code + 4
City State Zip Code + 4
text OK?text OK?
text OK? text OK?
Paperwork Correspondence Contact Name: _______________________________ Relationship to Camper: _________________
1st E-mail: _________________________________________________ 2nd E-mail: _________________________________________________
1st Phone: (________) ___________-___________________________ 2nd Phone: (________) ___________-___________________________
Correspondence Contact Address: _______________________________________________________________________________-___________
Payment Correspondence Contact Name: ________________________________ Relationship to Camper: __________________
1st E-mail: _________________________________________________ 2nd E-mail: _________________________________________________
1st Phone: (________) ___________-___________________________ 2nd Phone: (________) ___________-___________________________
Correspondence Contact Address: _______________________________________________________________________________-___________
text OK? text OK?
text OK?
CONTACT INFORMATION (primary contact will serve as initial contact for emergency and non-emergency situations)
Primary Contact: _________________________________________________ Relationship to Camper: ___________________________
1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________
Secondary Contact: _______________________________________________ Relationship to Camper: ___________________________
1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________
text OK?
text OK?
text OK?
text OK?
First Last
First Last
ADDITIONAL CONTACT INFORMATION (Please list two contacts NOT listed above)
Primary Contact: _________________________________________________ Relationship to Camper: ___________________________
1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________
Secondary Contact: _______________________________________________ Relationship to Camper: ___________________________
1st Phone: (________) ___________-________________________ 2nd Phone: ________) ___________-________________________
Event Name & Description **all camp dates are subject to change **
Dates of Event
Full Price
FP Deposit
EB Date
EB Price
EB Deposit
Youth Spring Weekend (ages 6 - 16), Northwoods Village
February 16 - 17
$190.00
$95.00
January 16
$165.00
$85.00
Young Adult Spring Weekend (ages 17 - 30), Northwoods Village
February 2 - 3
$190.00
$95.00
January 2
$165.00
$85.00
Adult Spring Weekend (ages 31 +), Northwoods Village
March 2 - 3
$190.00
$95.00
February 1
$165.00
$85.00
Youth Summer Weeklong (ages 6 - 16), Northwoods Village
June 10 - 14
$575.00
$280.00
May 10
$525.00
$265.00
Youth Summer Weekend (ages 6 - 16), Northwoods Village
July 27 - 28
$190.00
$95.00
June 27
$165.00
$85.00
Rustic Young Adult Summer Weeklong (ages 17 - 30), held at Camp Tanglewood
June 3 - 7
$575.00
$280.00
May 3
$525.00
$265.00
Modern Young Adult Summer Weeklong (ages 17 - 30), held at Northwoods Village
July 6 - 10
$575.00
$280.00
June 6
$525.00
$265.00
Rustic Adult Summer Weeklong w/Volunteers (ages 31 +), held at Camp Tanglewood
July 1 - 5
$575.00
$280.00
May 31
$525.00
$265.00
Modern Adult Summer Weeklong w/Volunteers (ages 31 +), held at Northwoods Village
July 29 - August 2
$575.00
$280.00
June 28
$525.00
$265.00
Adult Summer Weeklong w/Caregivers (ages 31 +); must have a caregiver accompany
August 5 - 9
$575.00
$280.00
July 5
$525.00
$265.00
Youth Fall Weekend (ages 6 - 16), Northwoods Village
September 21 - 22
$190.00
$95.00
August 21
$165.00
$85.00
Young Adult Fall Weekend (ages 17 - 30), Northwoods Village
October 12 - 13
$190.00
$95.00
September 12
$165.00
$85.00
Adult Fall Weekend (ages 31 +), Northwoods Village
October 26 - 27
$190.00
$95.00
September 26
$165.00
$85.00
Culinary Camp - for ages 6+ Northwoods Village, no scholarships available
March 30 - 31
$190.00
$95.00
February 28
$165.00
$85.00
Camp Sunrise/TBI/OBI - for adult conquerors of brain injuries, Northwoods Village
April 12 - 14
$250.00
$125.00
March 12
$225.00
$115.00
MPH Motorcycle Race Weekend - for ages 6+ Northwoods Village
May 4 - 5
$190.00
$95.00
April 4
$165.00
$85.00
Camp Horizon - for ages 6+ with Prader-Willi Syndrome, Northwoods Village
May 28 - June 1
$575.00
$280.00
April 26
$525.00
$265.00
Neuromuscular Summer Weeklong - for adults with neuromuscular disorders
July 21 - 26
$575.00
$280.00
June 21
$525.00
$265.00
Theatre Camp - for ages 6+ Northwoods Village, no scholarships available
November 9 - 10
$190.00
$95.00
October 9
$165.00
$85.00
Christmas Craft Camp - for ages 17+ Northwoods Village, no scholarships available
December 7 - 8
$190.00
$95.00
November 7
$165.00
$85.00
Page 3
Check the box to sign up for your Fall Weekend Camp
Last First Middle Camper Name: ________________________________________________________________________________________
Check here to sign up for all Other MPH Camp Events
This Year’s Make Promises Happen Camps
Check the box to sign up for your Spring Weekend Camp
Check the box to sign up for your Summer Camp
Please Note - your camper’s reservation will be placed on “hold” until everything has been received.
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
Page 4
CAMPER HEALTH AND WELL-BEING INFORMATION
Last First Middle
Camper Name: _______________________________________________________________________________________________
Health History (Please check and explain any past health issues below)
Heart Defect
Heart Disease
Mumps
Poison Ivy
Poison Oak
Diabetes
Mononucleosis
Chicken Pox
High Blood Pressure
Hay Fever
Ear Infections
Swimmer’s Ear
Measles
Asthma
Other: __________________
Seizure History
This camper has an active seizure condition Yes No Date of last seizure: __________________________
If yes, type/s: ____________________________________________________ Frequency: ____________________________________________
Typical length of seizure/s: _____________________ Trigger/s: ______________________________________________________________
Please describe any relevant health history: ______________________________________________________________________________
Medical Insurance Information
Camper’s primary care physician’s name: ________________________________________________________________________
Phone Number (______)________-_____________ Camper is covered by family health insurance Yes No
Insurance Company _________________________________________ Policy Number _______________________________
Subscriber____________________________________________________ Insurance Company (______)________-_____________
The following non-prescription OTC medications may be used on an “as needed” basis to manage illness and injury.
Please check all that apply. Central Oklahoma Camp/MPH has permission to give camper the following:
laxatives for constipation (Ex-Lax) aloe vera gel, topical
calamine lotion, topical Bismuth Subsalicylate for diarrhea (Pepto-Bismol)
lice shampoo or cream (Nix or Elimite) antibiotic cream, topical
sore throat spray generic cough drops
Diphenhydramine antihistamine/allergy medicine (Benadryl) Dextromethorphan cough syrup (Robitussin DM)
antihistamine/allergy medicine Guaifenesin cough syrup (Robitussin)
Acetaminophen (Tylenol) Pseudoephedrine decongestant (Sudafed)
Phenylephrine decongestant (Sudafed PE) Ibuprofen (Advil, Motrin)
Allergies Camper has no known allergies. Camper is allergic/sensitive to (check appropriate boxes):
Food Medicine The environment (insect stings, hay fever, mold, pollen, etc.) Other (use line below):
Diet Camper eats a: regular vegetarian gluten free reduced calorie heart healthy other:
____________________ diet. Camper has a dietary restriction: _________________________________________________________
Camper has a food allergy/sensitivity; has special food/liquid needs as described:
*If camper requires special foods, please bring substitute/supplemental foods, labeled with camper name and directions to prepare them.*
Please be advised that our food and kitchen are not soy, peanut/nut, dairy or gluten free.
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
Immunization Records, if known: Date Date Date Date Date
DTP (Diphtheria,Tetanus and Pertussis)
OPV (Oral Poliovirus Vaccine)
MMR (Measles, Mumps, Rubella)
HbPV (Haemophilus b Conjugate Vaccine)
Tuberculin
** TET-TOX (Tetanus Toxoid)
Other:
Other:
**Date of last Tetanus shot , if known, is requested for all participants ** Date: __________________________ (MM / DD / YYYY)
STOP - THIS SECTION MUST BE FILLED OUT BY YOUR PHYSICIAN
Physicals conducted for school, sports, or yearly exams will be accepted in lieu of the one below, provided they
are dated within the one (1) year span of camp attendance; must be kept current to attend camp.
Medical Exam Information - To be completed by a health care provider and dated within the year of camp(s) to be attended
Blood Pressure: ______________ Weight: ______________ Height: ______________
Is this person able to participate in an active camp and/or recreation program? Yes No
(Examples of camp activities include hiking, fishing, boating, swimming, dancing, field games, etc.)
Any limitations or restrictions while at camp? Yes No If yes, describe on the line provided below:
_____________________________________________________________________________________________________________________________
Any medical concerns to be monitored at camp? Yes No If yes, describe on the line provided below:
____________________________________________________________________________________________________________________________
(This includes allergies, asthma, heart conditions, blood pressure, blood sugar, weight, etc.)
Any meal plans or dietary restrictions to be monitored at camp? Yes No If yes, describe below:
_____________________________________________________________________________________________________________________________
(This includes puree, dietary supplement, food allergies and sensitivities, portion limitations, low carb, low calorie, etc.)
Comments: ____________________________________________________________________________________________________________________
Date of Physical Exam: _____________________________ Today’s Date: _____________________________
I have reviewed the relevant portions of the Camper Registration Packet and have discussed the camp program with
the camper’s parent/s or guardian/s. It is my opinion that the camper is physically and emotionally fit to participate in
an active camp program, except as previously noted. I am aware of all medications prescribed to this individual and see
no contraindications. This person can also receive all “as needed” medications and treatments checked, or indicated on
the MARS, when deemed necessary by Central Oklahoma Camp and Conference Center, Inc.
Physician’s Signature/Stamp: _______________________________________________________________________________________________
Physician’s Name (please print): _____________________________________ Phone Number: (______)________-______________
Page 5
Camper Name: ____________________________________________________________________________________________________
Last First Middle
Page 6
home mobile work home mobile work text OK? text OK?
City State Zip Code +4
Please fill this section out accurately and completely. If changes to medical condition and/or medication occur and are different from
what you listed on this form, contact the camp office as soon as possible, prior to camp. List all medications and treatments prescribed
to the camper including: lotions, creams, inhalers, liquids, allergy medications, cold medications, injections, and temporarily prescribed medi-
cation, including all over the counter medications, vitamin/mineral supplements, nutritional supplements, herbs, homeopathic remedies, other
treatments, etc. that camper is currently taking. Administration advice is greatly appreciated. If camper will not be taking medications, etc. at
camp, but takes them routinely, at other times, please list what is taken and in Comments section, please mention that they won’t be taken at
camp.
Medication Correspondence Contact Name: ___________________________________________ Relationship to Camper: ______________________________
E-mail: ________________________________________ Primary Phone: ( ) __________- _________________ Secondary Phone: ( ) __________- _________________
Correspondence Contact Address: ________________________________________________________________________________________________________-___________
Medications will be dispensed at B-Breakfast, L-Lunch, D-Dinner, HS-Hour of Sleep unless otherwise specified below under
“Comments or Special Instructions” section.
·If a medication is used for sleep purposes or will make camper very drowsy at bedtime, please mark it as HS as opposed to a specific time, as
bedtime at camp is not necessarily your camper’s normal bedtime.
·If medication needs to be dispensed at a specific time (for pain, blood pressure, blood sugar, or seizures, for instance), please make sure to list
specific time/s medication is to be administered as opposed to using approximations (B, L, D, HS); make sure to use the comment section.
Each item listed must include accurate name, strength, dosage, times, and comments/instructions as necessary. The following page will have a
continuation of this form, for your convenience; if you need more lines/space, please go online to print the form or make a copy of the pages.
Last First Middle
Camper Name: _______________________________________________________________________________________
Name of Medication Strength of Each Individual Pill and Route
Dosage At Each Time
Times use B, L, D, HS
if possible
Comments or Special Instructions crushed, with food or how medication is given at home
side effects, history of refusal or hiding medication
Ibuprofen - 200 mg, oral *Pill = Ibuprofen *Strength = 200 mg *Route = oral
200 mg B
200 mg L
100 mg @4:30 PM
100 mg HS
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
N/A <- Please check box if camper takes no medication, supplements, OTC remedies, etc.
Take with food and plenty of water.
Take 30 minutes before meal; take on empty stomach.
Split 200 mg tablet in half, crush, mix with pudding.
Split 200 mg tablet in half & take with water, might refuse.
<- Please check box if camper has a DNR (Do Not Resuscitate) order in place. Please provide a copy for camp.
Page 7
Last First Middle
Camper Name: _______________________________________________________________________________________
Name of Medication
Strength of Each Individual Pill and Route
Dosage
At Each Time
Times
use B, L, D, HS
if possible
Comments or Special Instructions
crushed, with food or how medication is given at home
side effects, history of refusal or hiding medication
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
CONTINUATION OF PAGE 4
Take with food and plenty of water.
Take 30 minutes before meal; take on empty stomach.
Split 200 mg tablet in half, crush, mix with pudding.
Split 200 mg tablet in half & take with water, might refuse.
***Please update camp whenever there is a change in medication and medical information.***
MOBILITY &
POSITIONING
*** Please check which best applies ***
Comments:
- uses wheelchair yes no manual electric
- bears weight yes no yes, with assistance
- transfers alone assistance
- list additional adaptive equipment for
mobility (walker, cane, braces, etc.):
- additional mobility comments (also list any restrictions on mobility):
Page 8
COMMUNICATION
(verbal, sign language, device, gazes)
Please check
Yes or No
Comments:
-verbal
- uses sign language
- uses communication device **please bring device**
- uses eye gazes (glances/shifts eyes towards)
- list key/special words or phrases used at home
BEHAVIOR CONCERNS
*** answers will NOT exclude individual, but
will ensure the best possible care ***
Please check
Yes or No
Comments:
- shows aggression toward others
- shows aggression toward self
- describe any negative behaviors
- describe helpful behavior
strategies/interventions
- has been restrained
*** If yes, list when and summarize the circumstances on the line below ***
- additional behavior information:
SWIMMING
(shallow, deep, equipment)
Please check
Yes or No
Comments:
-swims independently in shallow end
- swims independently in deep end
- submerges head under water
- enters pool without assistance
- comments concerning swimming, restrictions:
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
Last First Middle
Camper Name: ______________________________________________________________________________________________
Last First Middle
Page 9
FEEDING
(eating & drinking)
Independent Needs Verbal
Prompts
Needs Physical
Assistance
Comments:
- eats
- drinks
- needs special positioning/equipment describe/list:
HYGIENE
(shower, shampoo, brush teeth)
Independent Needs Verbal
Prompts
Needs Physical
Assistance
Comments:
- takes a shower
- shampoos hair
- dries off
- brushes teeth
- needs special positioning/equipment describe/list:
NIGHTTIME ROUTINE
check box & provide details
Please
check
Yes or No
Comments:
- sleeps through the night
- has special sleep habits
(list camper’s sleep habits, if any)
- has sleep positioning requirements
(photos are greatly appreciated)
- has history of wetting or soiling bed
(send extra bedding and/or bed pads)
TOILETING
check box & provide details
Independent Needs Verbal
Prompts
Needs Physical
Assistance
Comments:
- uses toilet appropriately
- asks to use the toilet
- wipes well
Camper Name: _____________________________________________________________________________________________________
UNPACKING/PACKING
& DRESSING
Independent Needs Verbal
Prompts
Needs Physical
Assistance
Comments:
- unpacks/packs self
- undresses/dresses self
- has catheter N/A describe:
- wears absorbent briefs N/A describe:
- uses adaptive equipment? N/A describe:
- has bathroom schedule N/A describe:
Page 10
MM / DD / YYYY
Initials: _______ Photo Release: I hereby give consent for participant to attend and participate in all programs and activities of Central Oklahoma Camp and the
Make Promises Happen program. Pictures, audio tapes and videotapes may be taken of participant for use in publicity that is in the proper inter-
est of Central Oklahoma Camp and the Make Promises Happen program. I will alert COC&CC/MPH staff if camper is in state custody and can-
not be photographed, due to lack of consent or other reasons.
Initials: _______ Field Trips/Transportation: I understand that the program may include not only normal activities conducted at Central Oklahoma Camp, but may
also include field trips and multi-day trips which may require transportation to and from locations, and trips which will involve walking and hiking
away from Central Oklahoma Camp. I hereby give permission for participant to participate in any and all such activities, which are super-
vised and deemed appropriate by qualified camp personnel.
Initials: _______ Activities: I understand that participant may take part in activities on the campground that could include a climbing wall, ropes course training,
archery, swimming, canoeing and other such activities of Central Oklahoma Camp and the Make Promises Happen program. I do hereby agree to
indemnify and hold Central Oklahoma Camp and the Make Promises Happen program and its agents, servants and/or employees harmless from any
and all damages, claims, expenses or costs of whatever nature, causes of action, suits and liability of every kind including attorney fees, for injury to or
death of participant or for damages to any property, arising out of or in connection with participant's use or occupancy of the premises or participation in
activities at Central Oklahoma Camp and the Make Promises Happen program, except where such injuries, misfortune, accident, or damages are
caused in whole or in part by the negligence of Central Oklahoma Camp and the Make Promises Happen program, or joint negligence of any
person or entity hired or contracted by Central Oklahoma Camp and the Make Promises Happen program.
Initials: _______ Cancellation of Participation: I understand that if I have misrepresented or failed to inform Central Oklahoma Camp and the Make Promises
Happen program of any special needs or disabilities that participant has, that Central Oklahoma Camp and the Make Promises Happen program may not
be able to provide appropriate support. If this situation occurs, I understand and agree that Central Oklahoma Camp and the Make Promises Happen
program will terminate participation in the program and I understand and agree that if participant must leave program because of un-
disclosed issues that no money will be refunded to me.
Initials: _______ I hereby give my permission for Certified Medication Administration staff to give medication to the camper
while at camp or recreation program. The health history is correct and accurately reflects the health status of the camper to whom it pertains. The
person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to
the health care provider selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health
care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the health care provider to hospitalize, secure
proper treatment for, and order injection, anesthesia, or surgery for this camper. I understand the medical information provided will be shared on
a "need to know" basis with camp staff. I give permission to photocopy the packet. In addition, the camp has permission to obtain a copy of my
camper’s health record from providers who treat my camper and these providers may talk with the program’s staff about my camper’s health
status. I understand that I will be contacted, at the emergency numbers listed on the registration form, by the camp staff once emergency medical
treatment has been secured.
Initials: _______ Cancelation Policy: I understand that refunds and/or deposit credits will only be applied if notification is given to camp office at least 1 week (7
days) prior to the event.
Initials: _______ E-mail Communication: I understand that my name will be added to a web service in order that I will receive communications via E-Mail, if I
provided an E-Mail address for communication purposes (fundraising, camp calendar and registration of events, etc.). I understand that I can alter
my subscription from the web service at any time, that it is my responsibility to update the camp with any changes to my contact information, any
information that I provided.
Initials: _______ Sharing of Information: I give Central Oklahoma Camp and Conference Center/Make Promises Happen permission to share my name and con-
tact information with support groups, agencies and organizations, camper families. I understand that camp will not share sensitive information, such
as diagnosis, medical, financial, etc. Furthermore, I understand that the purposes of sharing the information would be to provide support to other
campers, their families and guardians, and for returning any missing items that went home with another camper.
The camper and the guardian shall protect, hold free and harmless, defend and indemnify Central Oklahoma Camp & Conference Center and the Make Promises
Happen program (including its officers, agents, volunteers and employees) from all liability, penalties, costs, losses, damages, expenses, causes of action, claims or judg-
ments (including attorneys' fees and/or fines and penalties) which arise out of, or are in any way connected with the performance of the work and/or services provided
under this contract. This agreement shall apply to any acts or omissions, negligent conduct, whether active or passive, including acts or omissions, injury, damage
and/or loss of property and misfortune or accident on the part of named child or their agents and/or representative. EXCEPT that this agreement shall not be appli-
cable to injury, misfortune, accident or damage to property arising from the sole negligence of Central Oklahoma Camp & Conference Center and the Make Promises
Happen program, its officers, agents, volunteers and employees.
Signature of Legal Guardian/Agent Acting on Behalf of the Legal Guardian: Date:
_______________________________________________ ____________________
Legal Guardian or agent for camper, must initial each section and sign and date below as indicated.
When necessary, oral consent may be given, witnessed, noted and signed accordingly.
Last First Middle
Camper Name: _________________________________________________________________________________________________
Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041
Help camp staff get to know your camper and provide any additional
information about him/her in the box provided.
Last First Middle
Camper Name: ______________________________________________________________________________________________
For your own protection and convenience, please make a copy of each of the pages, all paperwork you submit to camp.
Please use the checklist provided below, checking the boxes below to ensure you have included all
information, prior to submitting your camper’s MPH Camp Registration paperwork.
REMEMBER:
There is NOT a reservation for your camper’s MPH camps until ALL necessary criteria have been met:
Completion of all preceding pages, with all pages completely filled out, dated, signed
Supplemental paperwork, if necessary, which may include, but is not limited to:
1) a MARS in lieu of medication page/s, with times of medication administration listed
2) a copy of an older physical, within the previous year, awaiting the current year’s physical with a note stating that the required
physical will be completed and sent on a specified date prior to camper’s arrival to camp, or a current physical from
Special Olympics, the doctor’s office, DHS annual that will be completed as described above
3) a copy of camper’s DNR and any instructions, if applicable
4) if using waivered services or a voucher as payment, a payment via Acumen or via Voucher letter
5) if the required deposits are not included, a proposed Payment Plan and/or Scholarship Request and any supporting documents
6) a copy of insurance cards, if camper has insurance
7) a copy of camper’s behavior plan, if applicable
8) any pictures showing positioning for feeding, sleeping, etc.
9) any beneficial information concerning camper’s day to day, daily living, likes/interests
A current head/shoulders picture of the camper (e-mail to [email protected]) or text it to 405-471-7965.
If you send a picture via USPS, and would like it returned, please provide a self addressed, stamped envelope.
The correct amount for deposits, and/or an amount agreeing with your proposed Payment Plan