Apply for Camp Wamp and Join the Adventure

Camp Wamp Camper Registration Application

Apply now for Camp Wamp. Please note this is a pre-acceptance form. There will be an interview process to follow before the camper is approved. Must be completely filled out in order to attain a spot for your camper.

Parent / Legal Guardian Contact Information

First Name

Last Name

Phone

Camper Information

Camper's Name

Camper Mailing Address

Street Address

City

State

Zip

Where Did You Hear About Us?

Tik TokFacebookInstagramLinkedInFriendOther

Date of Birth

Age

Camper Cognitive Age / Grade in School

Gender

Preferred Pronouns

COVID-19

The safety and well-being of our campers, their families, our volunteers, and our staff are of the utmost importance to us at Camp Wamp. We are taking all possible and appropriate measures to ensure everyone has a safe experience at Camp Wamp this summer.

As we continue to monitor developments regarding COVID-19, we are reviewing updates from the CDC, the ACA, and Department of Public Health daily. We understand the concern surrounding the possible impacts of our programs. We are paying close attention to local guidance and are following all preventive measures to protect the vulnerable population we serve.

Covid-19 Vaccination Status?

Initial Vaccination CompleteBooster CompleteNot vaccinated

Not Vaccinated Reason *

Medical exemptionReligious exemptionPlan to receive vaccination prior to June 2023

Does Camper reside in a facility, group home, or care home?

YesNo

Location and phone # where parents are going to be.

Residential facility name (if applicable)

Residential facility director name (if applicable)

Will parents be away from home while child is at Camp?

YesNo

Parent/Guardian Travel Details (if applicable)

Medical Information

In this section, we will be asking questions related to your camper and their disability. Please provide as much information as possible so that we are able to provide your camper with the best possible experience.

If you feel that your camper has exceptional needs or complications that go beyond the scope of this form, please feel free to contact us directly at 1.800.381.6891 ext.1.

Camper Disability (please be specific)

Tell us about your camper's mobility. (check all that apply)

Walks IndependentlyWears a Helmet for Protection against FallsUses a Manual WheelchairUses an Electric WheelchairUses CrutchesUses a Lift to Transfer (Hoyer Lift, etc.)Uses a Walker

Does your camper use a communication device? (if yes it must be at camp with the camper)

YesNo

Does your camper sleep through the night?

YesNo

Please describe any night care needs (bed rails, etc.)

Does your camper need help dressing?

YesNo

What help does your camper need while eating? (please check all that apply)

No AssistanceAdaptive UtensilsPartial AssistanceFull Assistance

What help does your camper need in toileting? (please check all that apply)

No AssistancePartial Assistance - Can TransferPartial Assistance - Can Not TransferFull Assistance

Does your camper (check all that apply)

Have accidents with bladder control?Have accidents with bowel control?Wear Diapers?Use Chucks?Use a Foley Catheter?Use a Urinal Bag?Have Menstrual Difficulties?

Does your camper have seizures?

YesNo

If your camper has seizures, please describe the following: -Type -Frequency -Triggers -Emergency Care -Date of Last Seizure

Does your camper have a cardiac condition?

YesNo

If your camper has a cardiac condition, please list care and activity limitations.

Does your camper: (please check all that apply)

Have difficulty hearing?Wear a hearing aid?Have difficulty speaking?Wear glasses?Fatigue easily?

Please list and describe any special precautions you wish to have observed while your camper is at camp.

Social History

In this section, we will be asking questions related to your camper, their social history, and their readiness for camp. Please provide as much information as possible so that we are able to provide your camper with the best possible experience.

If you feel that your camper has exceptional needs or complications that go beyond the scope of this form, please feel free to contact us directly at 1.800.381.6891 ext.1.

Has your camper (please check all that apply)

Never stayed overnight without Parents/GuardiansStayed overnight with relativesStayed overnight with friendsAttended day camp(s)Attended resident camp(s)

What type of behavior does your camper exhibit when they are unhappy?

Please describe your camper's favorite activities and hobbies.

Does your camper exhibit dangerous tendencies that could result in harm to self, other campers, or staff?

YesNo

If YES to the above question, please describe.

Camp Wamp Sessions

Please select your preferred Camp Wamp session:

July 9, 2023 - July 15, 2023 (ages 13-18)July 16, 2023 - July 22, 2023 (ages 8-12)July 23, 2023 - July 29, 2023 (ages 13-18)July 30, 2023 - August 5, 2023 (all ages)

reCAPTCHA helps prevent automated form spam.

The submit button will be disabled until you complete the CAPTCHA.

Contact Information