Camper Level of Function - New

  • This form is required for new campers.
  • Very Important: After you click on Save and Continue, you may need to wait a few minutes for your changes to stick. Do not panic if you save your work and go back to review your changes - wait 5 minutes then check your edits using the link you received via email.
  • Camper Name * Required
  • Level of Function

  • Are there any special precautions the applicant needs that camp staff need to know about? (For example, swallowing, diabetes, asthma, difficulty with medicines?)
  • Are there particular habits or concerns camp staff should be aware of (for example, food dislikes, sleeping patterns, wandering, inappropriate language or behavior)?
  • Does applicant use: * Required
  • Can applicant propel wheelchair indoors/outdoors? (select all that apply)
  • Level of Assistance

    Please indicate the level and type of assistance the applicant requires for each of the following, as well as any type of equipment that is needed or used at home.
  • Is the applicant able to transfer him/herself from chair to bed, bath, or toilet? * Required
  • Eating continued-check all that apply
  • Toileting continued - check all that apply
  • Issues & Strategies

    Please address the following if applicable and provide details and strategies that may be helpful for camp managers to know. Enter NA if not applicable.
  • Is the applicant's speech understandable? If no, how does the applicant make his/her needs and wants known?
  • Criminal History * Required
    Has the applicant ever been charged with a misdemeanor or felony?
  • Review

    Please carefully review your answers. Remember that your application is NOT considered complete until all of the additional forms are completed and signed.