We do our best to ensure that Camp Akeela will be a great fit for your child. To that end, please be as open and honest as possible as you answer these questions. We recognize you may not be able to complete this in one sitting, and you are able to save and return to the form by clicking the “Save & Resume Later” link at the bottom. Please don’t hesitate to reach out with any questions!

Camper Name *

First

Last

Camper Grade *

Grade for CURRENT School Year (the grade your camper will be FINISHING before camp)

Parent Name *

First

Last

We are most likely interested in: *

• First Session (June 22 - July 15)
• Second Session (July 18 - August 10)
• Flexible or unsure

1. It's typical for children to feel uncertain about attending Camp Akeela for the first time. Participating in this application process, watching videos, and reviewing our website will hopefully help! Once campers arrive at Camp Akeela, they have to be motivated to participate in the program, including less preferred activities. As things stand today, what are your child's feelings about attending Camp? How motivated are they to attend? *

2. Has your child ever attended camp? Have they spent the night (or longer) away from home? What was that experience like for them? *

3. What would make this summer a success for your child? What do you hope they accomplish at Camp Akeela? *

4. What are your child's favorite activities at home, at school and in the community? *

5. How would you describe your child's interactions with their peers? How do peers respond to them? *

6. What situations (socially or otherwise) are particularly challenging for them to navigate? *

7. Successful Camp Akeela campers can navigate camp life (eg. hygiene, social emotional relationships, participation) without consistent 1:1 support from a staff member. How confident are you that your child can do so? *

8. What type of adult support does your child need to regroup and rejoin after a difficult moment, and how long does it typically take for them to move forward? *

9. How frequently is this type of support, intervention or redirection necessary? *

10. How does your child respond to requests from parents/guardians or teachers? (ie. How well do they follow rules and expectations?) *

11. Sleepover camp involves communal living and sharing space. Campers at Akeela must be able to maintain a schedule that is respectful to their bunkmates, which means remaining quiet before 7:30am wake up and settling down for bedtime (which varies by age, typically in the 8:45 - 9:30pm range). Do you have any concerns about your child's ability to maintain an appropriate sleep schedule at camp? *

12. Does your child have a history of verbal or physical aggression, destructive or self-injurious behavior? If so, please describe the circumstances, frequency and how long it's been since you have seen this behavior. What have been the most effective interventions? *

13. What special services, if any, does your child receive at school? (e.g. special education classroom, academic support, one-to-one aide, speech/language, social/emotional support) *

14. If your child sees a psychologist or mental health professional, how often do they meet? For how long has your child been working with this professional? In your opinion, how successful has the treatment been?

15. Does your child have any special health, hygiene, or dietary needs (including allergies)? *

16. Is there anything else you'd like us to know about your child? *

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