Application

KAMP KALEIDOSCOPE applications will be taken
beginning MIDNIGHT DECEMBER 31, 2010.

If you are interested in volunteering to help with our programs or in being a Kamp Kounselor, please click on the "Volunteers" tab and you will be taken to the TEAAM website to fill out a volunteer application there.

If you are interested in participating as a camper in TEAAM's ARAY Adventures, fill out the application below (be sure to check the box next to ARAY)
and someone will contact you.

Don't forget to submit your Registration Fee for your kamper!
*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)

Scroll down to fill out an application to be placed on Kamp Kaleidoscope’s waiting list.

Unsecured slots (those who have not paid their registration fees) will be released soon and applications on the waiting list will take priority in filling those slots.

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: