Winter Camp App

Please choose one of the following options in order to complete your child's application

Campers

My child attended camp in 2019
My child did not attend camp in 2019 but has been to camp/programs in the past
My child has never been to camp/has never gone through an intake process

Intake Form

The intake form is for new campers only. If you have already come to Camp AIM and would like to apply for winter camp you can hit "previous" and choose another option.

Name

First Last

Phone

Email

Please write a short description of your child

General Information

Parent's Names:

Name

Prefix First Last Suffix

Name

Prefix First Last Suffix

Telephone Numbers:

Home Tel:

Father's Cell Phone

Father's Email

Mother's Cell Phone

Mother's Email

Camper Profile

Name

First Last

Birth Date

Present Age

Please enter a number from 0 to 30.

Name of School Camper is Attending

Grade

Describe support currently receiving at school

1:1
small group settings
not applicable
Other - please describe

Please describe here

Emergency Contact:

Name

Prefix First Last

Phone

Relationship to Camper

Medical Information

Doctor's Name

First Last

Doctor's Phone Number

Diagnosis

Please list all diagnosis

Seizures: Does your child have known history of seizures or is your child taking meds to control seizures?

Yes
No

If yes, Please describe what a seizure looks like for your child.

If yes, Please describe the protocol to be followed in case of a seizure

Please list all prescribed medications that your child is taking and the reason they are taking each medication

Does your child have allergies?

Yes
No

If yes, to what are they allergic to

If yes, is an Epi Pen required?

Does your child have a G-Tube?

Yes
No

If yes, please clearly provide G-Tube feeding instructions

Does your child Have dietary restrictions?

Yes
No

If yes please list

List any other medical instructions

Please list any other relevant previous medical history or surgery history

Please describe your child's level of independence with self care (eg. feeding and toileting)

Describe your child's swim level

My child needs to be held or wear a neck floater
My child is comfortable in water but can not swim
My child is in lessons and has completed level: (fill out level below)
My child has never been in a pool before

My child has completed this level in swim lessons

Does your child have any specific Dislikes/Fears that we should be aware of?

Behavioral Techniques that work (ie. timer, charts)

Other good tips to know

Returning Camper

Camper's Name

First Last

Please let us know of any changes from the Summer Camp application

My child's medications have changed since camp

Yes
No

Please explain

My child has experienced behavioural changes

Yes
No

Please explain

My child has experienced dietary changes

Yes
No

Please explain

Payment Information

Winter Camp Costs $525.

Winter Camp

1:1

I am interested in 1:1 Staff for $175

Transportation

Morning Transportation
Afternoon Transportation

Pick Up Address

Drop Off Address

Pictures are how we tell parents the story of camp! Please choose your options for photo release below

My child is photo released.
I would like to discuss photo release options.

Total

$ 0.00 CAD

Payment Option

I would like to pay in full now
I would like to contact the office to set up a payment plan

Billing Email

Please enter the email you want to use for your billing information.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Address must match credit card billing address.

Credit Card

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Captcha

Name

This field is for validation purposes and should be left unchanged.