Application

NOW ACCEPTING APPLICATIONS FOR CAMP

Register for Summer Camp Now!!!

In years past, camper applications have not been available to families for Kamp Kaleidoscope until January 1 of each year. The construction of The Center Ridge Outpost has opened new possibilities for the future. Register now for Camp. The price for 1- session is $250.00, if you are interested in one of the 2-Session packages it will be $500 (see below).

Because the fees for camp are established based on fundraising success of each year this will be a great advantage. Due to the current economy we hope that we can keep the cost at this level but we cannot guarantee. So we are encouraging families to take advantage of this offer. This fee can be paid all at once or over the next three months in installments. If you do this and camp ends up costing more for the 2012 sessions, you will be paid in full! This fee will be non-refundable but, in the event that your child cannot attend the summer camp, the fee can be applied to other retreat programs.

Just to give you an idea of how this worked in 2011, summer camp cost per camper was actually $450. (Please keep in mind that this amount covers the room and board of the counselors, materials, and camp overhead expenses.) Every camper got a $200 credit, due to fundraiser success, leaving only the $250 balance to be paid. This could go up for 2012. We hope not but it is difficult to know at this point. So, act today!

Dates for Center Ridge Outpost Summer Camps 2012

(You don’t have to select now but you can)

*Available for 2-Session Opportunity

Camp Walapei (18+) *Session 1-June 11-13 *Session June June 14 -16

Kamp Kaleidoscope Session 1-June 18-20 Session 2-June 21-23

(Ages 7 to 17) *Session 3-June 25-27 *Session 4-June 28-30

Session 5-July 9-11 Session 6-July 12-14

*Session 7-July 16-18 *Session 8-July 19-21

You can contact TEAAM at 1-866-993-2437 or at takeaction@TEAAM.org

You can pay on line at www.TEAAM.org in our shopping cart.

Don't forget to submit your Registration Fee for your camper!
*Application is not official until Registration Fee has been received!*

Click Here if you would like to submit your Registration Fee online!
(You will be taken to the TEAAM Shop page)

Click here to print the Consent & Wavier form to be filled out & signed

along with the application

Click Here for Camp Packing List

IMPORTANT:
Camper Slots are not secured until registration fee has been paid.
Please state your Camp date preference in the comments box of your online payment form.
If submitting registration fee by mail, please include a note about date preference.
Preference is no guarantee of Camp assignment. TEAAM will be in contact with you to confirm Camp assignment date.

Please choose the program(s) in which you are applying:

Kamp Kaleidoscope

Camp Walapei

Aray

AWB

About Me:

My name is (First and Last):

I like to be called:

My Birthday is:

I am years old:

I am in grade:

My eyes are:

My hair is:

I am this tall:

I weigh this many pounds:

My T-Shirt size:

About My Family:

Contact Email Address

Mother:

Father:

Step-Mother:

Step-Father:

Grandma(s):

Grandpa(s):

Sister(s):

Step-Sister(s):

Brother(s):

Step-Brother(s):

My address is:

My City is:

My State is:

My zip code is:

My phone number is:

My family's cell phone is:

Emergency Information

If you can't reach my family, please call these people:

Name:

Relationship

Phone Number:

Name:

Relationship

Phone Number:

Name:

Relationship

Phone Number:

Medical Information:

Take medications:

I do

I do not

When I take my medication, you might want to watch out for these side effects:

About My Health:

I have this medical condition (i.e. asthma):

Have seizures:

I do

I do not

Please watch out that this doesn't happen with my health or body (i.e. rash or lethargic):

If it happens, you must do this:

I need help doing the following:

I use the following equipment and for these reasons:

I am allergic to the following bugs, plants, etc. (i.e. allergies/poison ivy):

I was recently ill or hospitalized for:

My Typical Day:

I usually get up at this time:

My favorite things to do are:

I get really happy when we do this:

I get really upset when we do this:

I usually take a nap at this time:

When I nap, this helps me to sleep:

I usually go to bed at this time:

When I go to bed, this helps me to sleep:

This also helps me to go to sleep:

I have trouble sleeping when this happens (i.e. lightening, storms, noise):

Mealtimes:

I usually eat at these times:

Breakfast

Snack

Lunch

Snack:

Dinner:

Snack:

Things I really like to eat:

Things I really DON'T like to eat:

Things I am allergic to and CAN'T EAT NO MATTER WHAT:

My Favorite Things

Books

Movies

Games:

Activities

Friends:

Toys:

Other Items:

Things I need Help With:

Sometimes I get upset because of these things:

Here are some things that may help me feel better:

When I get upset, I might say or do this:

Other helpful suggestions:

These things might irritate me:

Here's how you can help me calm down:

Communication:

Here are some ways to communicate with me so that I'll understand you:

Here is how I communicate some of my needs:

Check all that apply:

Sometimes I say things that you might not understand. I use phrases that don't seem to make sense (.ie. 'no feelies' might refer to the tags on my shirt scratching my skin).

Sometimes I tend to wander. Keep a special eye out.

Don't ignore me just because you can't understand me. Staying away from me just makes me move anxious.

Don't take things that I say personally. I usually don't mean them directly at you.

Don't move toward me too quickly. It scares me.

Sometimes I can't sit still for very long.

Sometimes I argue but I really can't help it. Arguing with me just makes things worse and I get over stimulated.

Sometimes I do things without thinking them through first or considering the dangers.

I only eat certain foods. If you force me, I usually vomit mostly because of the textures that my body can't handle.

TEAMM'S Adventure Based Programs

Application

About Me:

About My Family:

Emergency Information

Medical Information:

About My Health:

My Typical Day:

Mealtimes:

My Favorite Things

Things I need Help With:

Communication: