EmailMeForm
Camp Teacher Information Form 2025
In order to provide the best camp experience, information from the child's teacher is extremely important. Please take a few minutes to give Groton Parks & Recreation some information about your student.
Please understand the two different camps:
Camp Button (1/2 day)
Camp Button is a specialized camp for children ages 5-13 who require a more individualized camp experience. A typical Camp Button child is in a school program that is specific to their learning, behavioral and social needs based on their Individual Education Plan (IEP). The profile of a Button camper is a child who may have an educational classification of intellectual disability, autism, multiple disabilities or other health impairment. They are often in specialized programs such as ABA or self-contained settings, and require smaller settings or higher staff to child ratios. Camp Button provides activities, experiences and field trips that are accessible to each camper based on their level of cognition, adaptive abilities, sensory needs and social skills. Campers will have opportunities to engage in whole group games, small group activities and are provided individualized assistance from camp staff based on their level of need. Accommodations and modifications recommended by parents and the school team are considered and implemented based on accessibility at camp.
Discover Camp (8 hour camp)
Discover Camp is a camp for children ages 5-12 who can tolerate typical camp environment. The campers are capable of participating in group activities that include sports, arts and crafts, outdoor games, literacy, drama, music, and dress up days all within a caring and safe environment.
The groups tend to be 20-30 in a particular age group with a ratio of staff. The entire camp is approx. 125 children and there is a significant amount of sensory input.
The decision of which camp will be decided by the Groton Parks and Recreation with input from parents and teachers
Please take a few minutes to give Groton Parks & Recreation information. Thanks!
Participant Information
Participant Name
*
First
Last
Grade
Please select
Pre-school
1
2
3
4
5
6
7
8
9
10
11
12
Not in school
Birthdate
Parent has signed HIPAA-Compliant Authorization for Exchange of Health & Education Information
Yes
No
Please upload HIPAA Form
Teacher's Name
First
Last
Teacher Phone
###
-
###
-
####
School
Primary Diagnosis/Disability
*
Teacher Email
Has the camper had aggressive behaviors during the last 2 months?
*
Yes
No
Does the student have
*
IEP
504
Do you think the child need para support to be successful at camp?
*
Yes
No
If the child would be successful with para support, what would be your recommendation?
1:1
2:1
3:1
Does the child need a small, less stimulating environment to be successful (special needs camp)?
*
Yes
No
Possibly
Can the child handle camp with approx. 100 children at a site, with group sizes about 15-20)
*
Yes
No
Possibly
Does the child have aggressive behaviors that you would recommend an aid to be PMT trained?
*
Yes
No
Would the child be safe without a PMT trained aid?
*
Yes
No
Unsure
Does the child follow a specific behavior plan at school?
Yes
No
File Upload - Behavior Plan
Add File
Will the child be attending summer school?
Yes 4 weeks
Yes 6 weeks
No
Unsure
List Positive Attributes of the Participant
Please select equipment the child uses at school
Weighted Vest
Rifton Chair
Hearing Aid
Communication Board
Pecs Board
brushing
Other Device(s)
Behavior/Personality
Describe the best way to get the participant involved in activities.
Please identify the students stressors and how they are managed.
Describe the best way to introduce or explain new tasks and make transitions between activities.
Describe what types of things frustrate or discourage the participant.
Describe the best way to re-direct or engage the participant.
List any behavior strategies used that are successful for this student.
Please add any additional information that will be helpful in the success at camp.
Will the parent be inviting Eileen Cicchese from Groton Parks and Recreation to the PPT to better undertsand the camper?
Yes
No
Who is completing form and relationship to camper.
Signature
Clear