Every Child Plays Needs Assessment Parent and Child Information Parent/Caregiver Name * First Name Last Name Email * Please use the same email address provided on the camp application. Child's Name * First Name Last Name General Needs and Abilities What areas or challenges does your child need additional support in to thrive throughout their day? * Will your child need to be accompanied by a support professional to participate in the camp (e.g. behavioral therapist, nurse, etc.)? * Yes No If yes, please describe: Mobility and Physical Needs How does your child ambulate (move around)? * Independently Uses a mobility aid (e.g. wheelchair, walker, crutches, etc.) Needs assistance with mobility Are there any physical accommodations or modifications that will help your child participate comfortably in camp activities? * Does your child have any hearing-related needs or use any hearing supports (e.g., hearing aids, FM system, cochlear implant)? * Yes No If yes, please describe: Does your child have any vision-related needs or use any vision supports (e.g., glasses, contacts, magnifiers, assistive technology)? * Yes No If yes, please describe: Is your child toilet trained during the day? * Yes No If no, please describe any support your child may need: How does your child indicate their need to use the bathroom (e.g. verbal communication, gestures, jumping, etc.)? * Health and Safety Will your child need any medications or medical care during the camp? * Yes No If yes, please describe: Are there any safety concerns we should be aware of (e.g. flight risk, puts objects in mouth, self-injury, etc.)? * Does your child have any dietary restrictions, preferences, or feeding assistance needs? * Yes No If yes, please describe: Communication and Interaction How does your child primarily communicate? * Speaking Nonspeaking (e.g. gestures, body language) Augmentative and Alternative Communication (AAC) Device Other If other, please describe: What language(s) does your child speak and understand in different settings? At home: * At school or with peers: * Does your child prefer to communicate in one language over another? * Yes No If yes, what language? Does your child follow verbal instructions independently? * Check all that apply Yes With support When paired with written directions With close adult proximity With extra time With repeated instructions Does not typically follow verbal instructions (e.g. prefers self-directed activities, may need alternative support strategies) What's the best way to support your child's communication? * Sensory Needs and Preferences Tell us about any sensory differences or preferences we should know about. * Check all that apply Auditory (sounds, noise) Touch (textures, messy play) Visual (lights, colors) Movement (force, chewing, personal space) Motion (jumping, spinning) Smells (environment, food) Tastes (food) None Please provide specific details about your child's sensory preferences or sensitivities in the areas selected above. Does your child benefit from specific sensory tools or strategies? (e.g. noise-canceling headphones, chew necklaces, fidget toys, etc.) * Yes No If yes, please describe: Social Skills and Peer Interactions How does your child interact with peers? * Check all that apply Seeks out interaction Prefers independent play or parallel play Avoids interaction Slow to warm up Drawn to big body play with peers Values having his/her own space Does your child need behavioral support with group activities or transitions between activities? * Yes No If yes, what strategies work best? (e.g., visual schedules, movement breaks, specific phrases, sensory tools, redirection techniques, etc.) What are your goals for your child’s participation in this camp? (e.g. social interaction, independence, building new skills, etc.) * Is there anything else you would like us to know about your child? * Thank you! Your Needs Assessment has been submitted. We will be in touch by March 1st regarding camp admission.
