SNFC Application 2020 | Whispering Winds

Application process:
1. Fill out and submit application online.
2. Call to schedule a phone interview to review application with SNFC coordinator Betty Britschgi (619-793-7997) within seven days of application submission. This is a REQUIREMENT for NEW and RETURNING FAMILIES.

* required

Date:*

How did you hear about Special Needs Family Camp?:*

Family Name:*

Address:*

City:*

State:*

Zip:*

Best Phone Contact:*

Secondary Phone:*

Email*:

Parish/Church:

Name Parent/Guardian 1:

Special Diet Parent 1:

Mobility Concerns Parent 1:

Name Parent/Guardian 2:

Special Diet Parent 2:

Mobility Concerns Parent 2:

Number of typical siblings attending camp:

Name Typical Sibling #1:

Date of Birth:

Special Diet, if any:

Name Typical Sibling #2:

Date of Birth:

Special Diet, if any:

Name Typical Sibling #3:

Date of Birth:

Special Diet, if any:

Name Typical Sibling #4:

Date of Birth:

Special Diet, if any:

Name Typical Sibling #5:

Date of Birth:

Special Diet, if any:

Mobility concerns for any siblings:

Please select your lodging preference below. View lodging descriptions and pictures . A $60 programming fee applies to each camper 4 years old and older:

Deluxe Lodge Room ($190 after $500 grant, programming fees apply): 2 bunk beds, some with one or two pull out trundles, sleeps up to five/six people. The main difference between this type of lodging and our Disciples/Dorm Village Rooms is that each room has its own, private restroom and shower facilities.

Disciples Room (No cost after $500 grant, programming fees apply): 3 bunk beds per room with one bed that can sleep 2 (max. 7 people total), priority given to larger families, shared restroom/shower facilities.

Dorm Village Room (No cost after $500 grant, programming fees apply): 2 bunk beds per room (max. 4 people,) shared restroom/shower facilities.

Preferred Lodging*:

CAMPER(S) WITH SPECIAL NEEDS

Number of campers with special needs attending camp:*

CAMPER WITH SPECIAL NEEDS 1 INFORMATION

Name Special Needs Camper #1:

Primary Disability:*

Secondary Disability:*

If your camper has an IEP, please email the following to office@whisperingwinds.org: A copy of the first page of the IEP which states primary disability and a copy of the page which states their present levels.

If your camper DOES NOT have an IEP, please explain why not:

Does camper have a documented medical diagnosis?

Birthdate:*

Height:*

Weight:*

Sex:*

Grade (in Fall 2020):*

Allergies:

Medications:

History of seizures? If so, what do they look like?:

Any sleep concerns?:

Other medical concerns:

CAMPER WITH SPECIAL NEEDS 1 MOBILITY
I = Independent SA = Some Assistance TA = Total Assistance

Mobility:*
ISATA

Explanation:

Do you require a 1st floor accessible room?:*

Do you require a service dog?:*

CAMPER WITH SPECIAL NEEDS 1 MEALS
I = Independent SA = Some Assistance TA = Total Assistance

Meals:*
ISATA

Explanation:

Special diet:

Food allergies:

CAMPER WITH SPECIAL NEEDS 1 TOILETING
I = Independent SA = Some Assistance TA = Total Assistance

Toileting:*
ISATA

Explanation:

CAMPER WITH SPECIAL NEEDS 1 SWIMMING
I = Independent SA = Some Assistance TA = Total Assistance

Swimming:*
ISATA

Explanation:

Swim vest or floaties required?:

CAMPER WITH SPECIAL NEEDS 1 COMMUNICATION

Primary language:*
EnglishSpanishSign

Primary Mode of Communication:*
VerbalVerbal (limited)Non-verbalSign language

Augmentative communication device:

Other/explanation:

CAMPER WITH SPECIAL NEEDS 1 BEHAVIOR
This information will be used to match your camper with the most appropriate Special Needs Buddy. Please be very specific.

Aggressive behavior?:*

If yes or occasionally, please explain:

Does camper have behavior goals?:*

If yes, please email to office@whisperingwinds.org

Does camper have a Behavior Support Plan (BSP) or Behavior Intervention Plan (BIP)?:*

If yes, please email to office@whisperingwinds.org

Other behavior concerns:

Is camper a flight risk?:

Camper dislikes or fears:

What motivates camper?:

Comments:

PLEASE READ CAREFULLY AND ACCEPT EACH ITEM
I give my consent that information on this application may be communicated to Whispering Winds Catholic Camp and Conference Center, Inc. staff and volunteers for the purpose of being equipped to provide the best care and assistance possible to all of our Family Camp participants

Accept?:*

Permission is given to Whispering Winds Catholic Camp and Conference Center, Inc. to use photographs (individual or group) and/or multi-media images and recordings in the best interest of Whispering Winds Catholic Camp and Conference Center, Inc. I understand that photographs/images/video that I take at any Whispering Winds Catholic Camp and Conference Center, Inc. functions are for my personal use only. Personal Internet use of any images/video/multi-media should be approached with caution with regard to misrepresentation.

Accept?:*

I release Whispering Winds Catholic Camp and Conference Center, Inc., its staff, volunteers and the Whispering Winds Catholic Camp and Conference Center, Inc. facility from all actions, damages, or personal injuries which may occur to me or a member of my family or invited guest(s). I understand, that in the event of a minor injury, I may receive first aid treatment. In the event of an emergency, injury or illness, emergency medical services and I will decide the best course of action.

Accept?:*

I realize that tobacco, alcohol, and illegal drugs are NOT PERMITTED ANYWHERE on the premises of Whispering Winds Catholic Camp and Conference Center, Inc.

Accept?:*

I understand that a parent or legal guardian must attend camp with their child(ren).

Accept?:*

Call to schedule a phone interview with SNFC coordinator Betty Britschgi – 619-793-7997 – within seven days of application submission. This is a NEW and RETURNING FAMILY REQUIREMENT.