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Camper Information & Bunk Request Form

We want to know more about your camper! As we begin placing campers together in bunks, we value your feedback and want to consider your camper’s unique tastes, interests, passions and quirks. Please take 2-minutes to tell us more about them.

Mental Health and Social History

Please know that by checking these boxes or answering yes to any of the following questions, you will not be disqualifying your camper from camp - you are helping set them up for success with us. The more we know, the more we can do to support your camper.
We want to partner with you to make sure that your child has the best camp experience. We treat this information with great care and trust and share only on a need to know basis.
Primary Contact Email*
Camper First Name*
Please check all that apply to :*
- Challenges with anxiety (such as performance anxiety, social anxiety, panic attacks etc)
- Challenges with depression, low mood or low energy
- Challenges with eating habits or body image
- Learning or processing challenges and differences
- Attentional or hyperactive challenges and differences (including ADD and ADHD)
- Sensory challenges (including over-stimulation with loud noises etc)
- Sleep challenges
- Social challenges (including difficulties making friends, experiences with being bullied or having bullied etc)
- Challenges with perfectionism or obsessive-compulsive traits
- None
Challenges with anxiety*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Depression, low mood or low energy*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Challenges with eating habits or body image*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Learning or processing challenges and differences*
Please elaborate on 's experiences with these challenges and differences.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges and differences?
Attentional or hyperactive challenges and differences*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Sensory challenges*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Sleep challenges*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Social challenges*
Please elaborate on 's experiences with these challenges and differences.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges and differences?
Challenges with Perfectionism or Obsessive-Compulsive Traits*
Please elaborate on 's experiences with these challenges.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Has your child experienced a loss, major change or traumatic experience that continues to impact them?
Has your child been to overnight camp before? Do you anticipate any challenges with homesickness? If Yes, please elaborate.
Does receive weekly or regular counseling?*
- Yes
- No
Do you want to schedule one or more check-in sessions for your child and their therapist during camp?*
If yes, someone from our team will follow up about this.
- Yes
- No
Has ever self-harmed or had thoughts of self-harm?*
- Yes
- No
Please elaborate on 's experiences with self-harm. Are there particular triggers/contexts that tend to set off or exacerbate self-harm behavior/thoughts for ? What strategies/supports are most helpful to regarding these challenges?*
Please elaborate on 's experiences with self-harm.
Are there particular triggers/contexts that tend to set off or exacerbate self-harm behavior/thoughts for ?
What strategies/supports are most helpful to regarding these challenges?
Has experienced suicidal thoughts?*
- Yes
- No
Has taken action on suicidal thoughts?*
- Yes
- No
Please elaborate on 's experiences with suicidal thoughts. Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ? What strategies/supports are most helpful to regarding these challenges?*
Please elaborate on 's experiences with suicidal thoughts.
Are there particular triggers/contexts that tend to set off or exacerbate these challenges for ?
What strategies/supports are most helpful to regarding these challenges?
Has been hospitalized over the past school year for mental health related reasons?*
- Yes
- No
Please elaborate on 's hospitalization.*
Please elaborate on 's hospitalization.
Is there anything else you would like to share about ?

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