Summer Camp Questionnaire

Get started by telling me a little more about your child and their exceptionalities.

Summer Camp Questionnaire

Child's first name

Last name

Date of Birth

Parent/Guardian name

Address

Phone

Preferred Method of Communication

Phone

What is your child’s official diagnosis (if any)?

Are there any medical concerns (e.g., allergies, medications, health conditions)?

What is your child’s primary mode of communication? (e.g., verbal, nonverbal, sign language, AAC device) and how does your child express their wants, needs, or discomfort?

Does your child have any specific concerning behaviors?

Does your child have any sensory sensitivities (e.g., sound, light, touch, texture)?

Are there any sensory activities your child enjoys?

What level of independence does your child have with activities like dressing, eating, and toileting?

Does your child have specific interests or hobbies (e.g., trains, art, music)?

Do you have any concerns or questions for me?

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