Required fields are marked with asterisks (*)

City of Stratford Day Camp Inclusion Intake Form

At the City of Stratford Day Camps, we are committed to creating a safe and inclusive environment for all. Your responses will provide us with infromation to best support your child's needs and ensure they have a positive experience at day camp.

Child's First Name

Child's Last Name

Child's Date of Birth

Child's Pronouns

What is the child's preferred camp location?

7-12

5-8

4-6

Please list which week(s) your child is interested in attending camp

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Contact Number(s)

Parent/Guardian Email Address

Please describe your child's needs

Does your child receive additional support and/or breaks at school?

Yes

If yes, please describe the nature and duration of the support/breaks

Please detail your child's likes and interests

Please describe your child's dislikes and triggers

When dysregulated, what behaviours might your child display?

Are there behavioural support strategies that help your child when experiencing dysregulation and promote positive behaviours at home?

Please describe any strategies your child uses to self-regulate

Please describe how your child interacts with other children and adults. How can we help their interactions in case of difficulty?

Is your child successful with daily transitions? Please describe any strategies that are useful in times of transition

What is the most effective way to give instructions to your child (verbally, visually, written, clear statements, etc)

**Seasonal Only** Each day, our camp visits the Lions Pool. Is your child comfortable swimming? Is there any information needed to ensure your child's safety at the pool?

What goals do you have for your child's experience at the City of Stratford Day Camp?

Please include any other information that can be used to improve your child's experience at the City of Stratford Day Camps

Thank you for taking the time to complete this intake form.

We understand that each child’s needs are unique, and we carefully consider every request on an individual basis. We also assess the availability and capacity of our inclusion coordinators to ensure the proper support is in place. In cases where our resources may be insufficient to fully meet the safety and wellbeing needs of a child, we are open to the involvement of external agencies, companions, or support staff to attend camp and provide additional assistance as necessary.

By submitting this intake form, you are not guaranteed a spot in our program. A staff member will follow up with you to review your intake form and provide further information.