EmailMe Form - Discover Camp Parent Information Form 2025

Child's Name *

First Last

Are you requesting a reasonable accommodation under the ADA for my child at camp. *

Yes

No

Child's Primary Diagnosis/Disability *

Birthdate *

MM / DD / YYYY

Parent/Guardian *

First Last

Primary Phone

### - ### - ####

Email

Alternate Phone

### - ### - ####

If your child will be attending Discover Camp, please indicate which weeks.

School Information

Teacher's Name *

First Last

School *

Teacher Email *

Teacher Phone *

### - ### - ####

Grade *

Does your child have an educational plan? *

No

IEP

504

No, but is being tested.

My child's accommodations at school are: *

no para support

shared para support

1:1

unsure

Will your child be going to summer school? *

No

Yes - 4 weeks

Yes - 6 weeks

unsure

Are you requesting an accommodation for your child at camp?
Please note that all accommodations are based on assessment of child's needs with help of parents, school, previous participation in camp, etc. Requested accommodations are not guaranteed and will be reviewed by the team to determine appropriateness for camp. *

Yes

No - I would just like the staff to be aware of my child's needs.

If no, what are the needs you would like us to be aware of?

List positive attributes of your child.

Please select all that apply. My child...

Is not toilet trained

Requires bathroom assistance

requires regular bathroom times

requires menstrual assistance

Medical Information

Will your child be taking medication during camp hours?

Yes

No

Describe any medical problems/injuries that could affect participation.

List all Allergies

If your child is subject to seizures, describe the type, frequency, and extent controlled by medication.

List ANY special diets, dietary restrictions, or food that may cause a behavior change.

List activities that the participant cannot take part in due to medical reasons.

Please adaptive equipment that your child uses. (check all that apply) Parents are responsible to supply the equipment.

Other Device(s)

Mobility

Please select all that apply

Other Adaptive Equipment or Assistive Device(s)

Communication

Describe communication methods your child uses (speech, written, sign language, device etc.).

Behavior/Personality

Does your child have a behavior plan at school?

Yes

No

unsure

If you answered yes, please upload a copy of the plan.

Describe any specific behavioral plans used at home or school with your child.

Describe the best way to get your child involved in activities.

Please identify your child's stressors/triggers and how they are managed.

Describe the best way to introduce or explain new taks and make transitions betwen activities.

Describe what types of things frustrate your child.

Describe the best way to re-direct or engage your child. How are they comforted?

List any behavior management strategies that are successful for your child.

Please list behaviors of concern

Describe any sensory sensitivities your child experiences.

List any suggestions for additional assistance you think your child might require to be successfully included in a recreation setting.

Social

How does your child adapt to new staff?

Please list recreational activities your child enjoys.

Water activities: please check all that apply

Select the size of group your child is most comfortable with.

Large

Small

One-to-one

Alone

Please check if your child needs assistance to socialize with peers.

Assistance required

If your child requires assistance, please describe.

Cognitive

Please check if your child is able to follow directions with two or less prompts.

Follows directions

How many minutes is your child able to stay on task?

Personal Care

Comments about Personal Care

Safety

Please select all that apply. My child...

is willing to stay with a group.

can be held responsible for his/her own belongings.

may wander or run away.

can recognize danger

can manage his/her own money.

Comments about Safety

Swimming

Please select all that apply. My child...

is able to swim.

requires a life jacket.

needs assistance with dressing.

Comments about Swimming

Authorization to Contact and Release of Information

Unless otherwise indicated, I grant permission to Groton Parks and Recreation to contact the school, teachers assistant, teacher, social workers, therapist or physician for the purpose of gathering or releasing information regarding this participant. The information will be used to provide the most effective plan for providing recreation services and proper placement in inclusion. All information will be kept confidential.