Camp Friendship Application 2017
Current School and Grade for 2016-2017
Parent/Guardian Phone Number(s)
Does your child have any dietary restrictions, allergies, or medical issues? Sensitivity to certain sounds, florescent lights, etc?
How did you hear about us?
What led you to seek this program for your child? (i.e. your own observations, recommendation from teacher, therapist, etc?) Does your child have any diagnoses, participate in a special education program at school, or receive any other special services (i.e. speech, OT, therapy, etc)?
Please describe your child's interests (favorite toys, TV shows, games, etc), favorite subjects, what he/she likes to do with free time at home and on the playground, as well as any extracurricular activities.
Please describe your child's current areas of need and any social skills deficits or challenges. What are your goals for your child in these areas? What would you like your child to be able to do as a result of participation in our program?
Please describe any current or past behavioral challenges, if any (i.e. has difficulty staying with a group, has trouble following directions, displays verbal or physical aggression such as hitting, biting, or kicking, tries to injure self, etc.) If your child has a behavior plan at school, please email it to firstname.lastname@example.org
Please provide the Name, email, and phone number for at least one teacher or therapist who knows your child well and can speak to his/her strengths and needs.
If there is anything else we should know about your child that would helpful in making our placement decisions, please share it here.
Please indicate which day(s) you can attend our "get-to-know-you" intake playdate for kids and parents. We will contact you to confirm which date you should attend. Please keep in mind we operate on a rolling admissions policy.
We will contact you about a date.
I would like my child to attend the following sessions:
Session 1: July 10 – 14 & 17-21
Session 2: July 24-28 & July 31-Aug 4
Do you need aftercare (3-5 pm)?
Unsure at this time
Thank you for your application to Kate McClain Social Skills.
We will be in touch soon!
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