Camper Registration – Camp Victory Texas Inc

Child's Full Name:

Name child is called:

Child's birth date:

Child's age (years):

Grade Level:

may this away

School Attending:

Caregiver Name

First

Last

Facility Name

Address:

Phone Number:

Alternate phone:

Pickup/Drop-off location (addresses to be provided to camper caregivers. Not available online)

Has the child spent time away from home at camp or similar setting in the past?

Child's ability to swim:

Does child have permission to swim at camp?:

Is child interested in riding a horse at camp?:

Does child have permission to ride a horse at camp?:

Does the child have any conditions that may affect participating in camp activities?

When did the child first report sexual abuse?

Who was involved in assaulting the child?

What are the two most important things we should know about this child?

What type of discipline is effective with this child?

What triggers this child's negative behavior?

What are the signs that this child's behavior is about to escalate?

What actions help de-escalate this child's negative behavior?

Shoe Size

Clothing sizes (shirts and shorts/pants)