MPH Camper Registration Packet

Page 1 Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

Name Phone Number Name Phone Number

Name Phone Number

Roommate Requests (we try to honor, no guarantee): 1) _________________ 2) _________________ 3) __________________

The people listed below may drop off/pick up camper. *Please contact the office if this information changes.*

1) ___________________________ (_____)_____-_____________ 2) ___________________________ (_____)_____-_____________

Accompanied by Caregiver? Contact office if changes. Yes No ____________________ (_____)_____-_____________

Check T-Shirt size: Youth S M OR Adult S M L XL 2XL 3XL 4XL 5XL Other: _________

Date: __________________________ MM / DD / YYYY

Last First Middle

MM / DD / YYYY

Camper Name: ___________________________________________________________ Nickname: ____________________________

Male Female Camper legally known as: ___________________________________________________________________

New Camper Returning Camper Date of Birth: ______________________ Age: ___________

BASIC CAMPER INFORMATION

Primary Disability: _____________________________________ Secondary Disability: _____________________________________

Camper requires one-on-one assistance: Yes No If yes, please explain: ________________________________________

Camper E-Mail, if any: __________________________________________ Camper phone, if any: (_______)________-____________

Referral Source: Advertisement Camp Resource Fair Word of Mouth Friends School Internet Sibling

Whom do we thank for the referral? ___________________________________________________________________________________

OPTIONAL Camper is from which one of the following ethnic groups (please check most predominant ethnic group):

African American, Black Native Hawaiian or other Pacific Islander Hispanic, Latino

Asian American Indian/Alaskan White, not Hispanic

Name home work cell home work cell

Name home work cell home work cell

Camper is own guardian Name/s of camper’s guardian/s, if not camper: _____________________________________

_________________________ (_____)_____-_____________ (_____)_____-_____________ E-Mail of guardian: ____________________

_________________________ (_____)_____-_____________ (_____)_____-_____________ E-Mail of guardian: ____________________

Camper’s address: _________________________________________________________________________________________________________

Camper lives in a group home or is with agency : __________________ Camper lives which OK county: ______________

First Last

First Last

home mobile work home mobile work

home mobile work home mobile work

text OK?

Page 2

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

CONTACT INFORMATION - emergency and non-emergency

home mobile work home mobile work

home mobile work home mobile work

home mobile work home mobile work

home mobile work home mobile work

City State Zip Code + 4

City State Zip Code + 4

text OK?text OK?

text OK? text OK?

Paperwork Correspondence Contact Name: _______________________________ Relationship to Camper: _________________

1st E-mail: _________________________________________________ 2nd E-mail: _________________________________________________

1st Phone: (________) ___________-___________________________ 2nd Phone: (________) ___________-___________________________

Correspondence Contact Address: _______________________________________________________________________________-___________

Payment Correspondence Contact Name: ________________________________ Relationship to Camper: __________________

1st E-mail: _________________________________________________ 2nd E-mail: _________________________________________________

1st Phone: (________) ___________-___________________________ 2nd Phone: (________) ___________-___________________________

Correspondence Contact Address: _______________________________________________________________________________-___________

text OK? text OK?

text OK?

CONTACT INFORMATION (primary contact will serve as initial contact for emergency and non-emergency situations)

Primary Contact: _________________________________________________ Relationship to Camper: ___________________________

1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________

Secondary Contact: _______________________________________________ Relationship to Camper: ___________________________

1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________

text OK?

text OK?

text OK?

text OK?

First Last

First Last

ADDITIONAL CONTACT INFORMATION (Please list two contacts NOT listed above)

Primary Contact: _________________________________________________ Relationship to Camper: ___________________________

1st Phone: (________) ___________-________________________ 2nd Phone: (________) ___________-________________________

Secondary Contact: _______________________________________________ Relationship to Camper: ___________________________

1st Phone: (________) ___________-________________________ 2nd Phone: ________) ___________-________________________

Event Name & Description **all camp dates are subject to change **

Dates of Event

Full Price

FP Deposit

EB Date

EB Price

EB Deposit

Youth Spring Weekend (ages 6 - 16), Northwoods Village

February 16 - 17

$190.00

$95.00

January 16

$165.00

$85.00

Young Adult Spring Weekend (ages 17 - 30), Northwoods Village

February 2 - 3

$190.00

$95.00

January 2

$165.00

$85.00

Adult Spring Weekend (ages 31 +), Northwoods Village

March 2 - 3

$190.00

$95.00

February 1

$165.00

$85.00

Youth Summer Weeklong (ages 6 - 16), Northwoods Village

June 10 - 14

$575.00

$280.00

May 10

$525.00

$265.00

Youth Summer Weekend (ages 6 - 16), Northwoods Village

July 27 - 28

$190.00

$95.00

June 27

$165.00

$85.00

Rustic Young Adult Summer Weeklong (ages 17 - 30), held at Camp Tanglewood

June 3 - 7

$575.00

$280.00

May 3

$525.00

$265.00

Modern Young Adult Summer Weeklong (ages 17 - 30), held at Northwoods Village

July 6 - 10

$575.00

$280.00

June 6

$525.00

$265.00

Rustic Adult Summer Weeklong w/Volunteers (ages 31 +), held at Camp Tanglewood

July 1 - 5

$575.00

$280.00

May 31

$525.00

$265.00

Modern Adult Summer Weeklong w/Volunteers (ages 31 +), held at Northwoods Village

July 29 - August 2

$575.00

$280.00

June 28

$525.00

$265.00

Adult Summer Weeklong w/Caregivers (ages 31 +); must have a caregiver accompany

August 5 - 9

$575.00

$280.00

July 5

$525.00

$265.00

Youth Fall Weekend (ages 6 - 16), Northwoods Village

September 21 - 22

$190.00

$95.00

August 21

$165.00

$85.00

Young Adult Fall Weekend (ages 17 - 30), Northwoods Village

October 12 - 13

$190.00

$95.00

September 12

$165.00

$85.00

Adult Fall Weekend (ages 31 +), Northwoods Village

October 26 - 27

$190.00

$95.00

September 26

$165.00

$85.00

Culinary Camp - for ages 6+ Northwoods Village, no scholarships available

March 30 - 31

$190.00

$95.00

February 28

$165.00

$85.00

Camp Sunrise/TBI/OBI - for adult conquerors of brain injuries, Northwoods Village

April 12 - 14

$250.00

$125.00

March 12

$225.00

$115.00

MPH Motorcycle Race Weekend - for ages 6+ Northwoods Village

May 4 - 5

$190.00

$95.00

April 4

$165.00

$85.00

Camp Horizon - for ages 6+ with Prader-Willi Syndrome, Northwoods Village

May 28 - June 1

$575.00

$280.00

April 26

$525.00

$265.00

Neuromuscular Summer Weeklong - for adults with neuromuscular disorders

July 21 - 26

$575.00

$280.00

June 21

$525.00

$265.00

Theatre Camp - for ages 6+ Northwoods Village, no scholarships available

November 9 - 10

$190.00

$95.00

October 9

$165.00

$85.00

Christmas Craft Camp - for ages 17+ Northwoods Village, no scholarships available

December 7 - 8

$190.00

$95.00

November 7

$165.00

$85.00

Page 3

Check the box to sign up for your Fall Weekend Camp

Last First Middle Camper Name: ________________________________________________________________________________________

Check here to sign up for all Other MPH Camp Events

This Year’s Make Promises Happen Camps

Check the box to sign up for your Spring Weekend Camp

Check the box to sign up for your Summer Camp

Please Note - your camper’s reservation will be placed on “hold” until everything has been received.

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

Page 4

CAMPER HEALTH AND WELL-BEING INFORMATION

Last First Middle

Camper Name: _______________________________________________________________________________________________

Health History (Please check and explain any past health issues below)

Heart Defect

Heart Disease

Mumps

Poison Ivy

Poison Oak

Diabetes

Mononucleosis

Chicken Pox

High Blood Pressure

Hay Fever

Ear Infections

Swimmer’s Ear

Measles

Asthma

Other: __________________

Seizure History

This camper has an active seizure condition Yes No Date of last seizure: __________________________

If yes, type/s: ____________________________________________________ Frequency: ____________________________________________

Typical length of seizure/s: _____________________ Trigger/s: ______________________________________________________________

Please describe any relevant health history: ______________________________________________________________________________

Medical Insurance Information

Camper’s primary care physician’s name: ________________________________________________________________________

Phone Number (______)________-_____________ Camper is covered by family health insurance Yes No

Insurance Company _________________________________________ Policy Number _______________________________

Subscriber____________________________________________________ Insurance Company (______)________-_____________

The following non-prescription OTC medications may be used on an “as needed” basis to manage illness and injury.

Please check all that apply. Central Oklahoma Camp/MPH has permission to give camper the following:

laxatives for constipation (Ex-Lax) aloe vera gel, topical

calamine lotion, topical Bismuth Subsalicylate for diarrhea (Pepto-Bismol)

lice shampoo or cream (Nix or Elimite) antibiotic cream, topical

sore throat spray generic cough drops

Diphenhydramine antihistamine/allergy medicine (Benadryl) Dextromethorphan cough syrup (Robitussin DM)

antihistamine/allergy medicine Guaifenesin cough syrup (Robitussin)

Acetaminophen (Tylenol) Pseudoephedrine decongestant (Sudafed)

Phenylephrine decongestant (Sudafed PE) Ibuprofen (Advil, Motrin)

Allergies Camper has no known allergies. Camper is allergic/sensitive to (check appropriate boxes):

Food Medicine The environment (insect stings, hay fever, mold, pollen, etc.) Other (use line below):

Diet Camper eats a: regular vegetarian gluten free reduced calorie heart healthy other:

____________________ diet. Camper has a dietary restriction: _________________________________________________________

Camper has a food allergy/sensitivity; has special food/liquid needs as described:

*If camper requires special foods, please bring substitute/supplemental foods, labeled with camper name and directions to prepare them.*

Please be advised that our food and kitchen are not soy, peanut/nut, dairy or gluten free.

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

Immunization Records, if known: Date Date Date Date Date

DTP (Diphtheria,Tetanus and Pertussis)

OPV (Oral Poliovirus Vaccine)

MMR (Measles, Mumps, Rubella)

HbPV (Haemophilus b Conjugate Vaccine)

Tuberculin

** TET-TOX (Tetanus Toxoid)

Other:

Other:

**Date of last Tetanus shot , if known, is requested for all participants ** Date: __________________________ (MM / DD / YYYY)

STOP - THIS SECTION MUST BE FILLED OUT BY YOUR PHYSICIAN

Physicals conducted for school, sports, or yearly exams will be accepted in lieu of the one below, provided they

are dated within the one (1) year span of camp attendance; must be kept current to attend camp.

Medical Exam Information - To be completed by a health care provider and dated within the year of camp(s) to be attended

Blood Pressure: ______________ Weight: ______________ Height: ______________

Is this person able to participate in an active camp and/or recreation program? Yes No

(Examples of camp activities include hiking, fishing, boating, swimming, dancing, field games, etc.)

Any limitations or restrictions while at camp? Yes No If yes, describe on the line provided below:

_____________________________________________________________________________________________________________________________

Any medical concerns to be monitored at camp? Yes No If yes, describe on the line provided below:

____________________________________________________________________________________________________________________________

(This includes allergies, asthma, heart conditions, blood pressure, blood sugar, weight, etc.)

Any meal plans or dietary restrictions to be monitored at camp? Yes No If yes, describe below:

_____________________________________________________________________________________________________________________________

(This includes puree, dietary supplement, food allergies and sensitivities, portion limitations, low carb, low calorie, etc.)

Comments: ____________________________________________________________________________________________________________________

Date of Physical Exam: _____________________________ Today’s Date: _____________________________

I have reviewed the relevant portions of the Camper Registration Packet and have discussed the camp program with

the camper’s parent/s or guardian/s. It is my opinion that the camper is physically and emotionally fit to participate in

an active camp program, except as previously noted. I am aware of all medications prescribed to this individual and see

no contraindications. This person can also receive all “as needed” medications and treatments checked, or indicated on

the MARS, when deemed necessary by Central Oklahoma Camp and Conference Center, Inc.

Physician’s Signature/Stamp: _______________________________________________________________________________________________

Physician’s Name (please print): _____________________________________ Phone Number: (______)________-______________

Page 5

Camper Name: ____________________________________________________________________________________________________

Last First Middle

Page 6

home mobile work home mobile work text OK? text OK?

City State Zip Code +4

Please fill this section out accurately and completely. If changes to medical condition and/or medication occur and are different from

what you listed on this form, contact the camp office as soon as possible, prior to camp. List all medications and treatments prescribed

to the camper including: lotions, creams, inhalers, liquids, allergy medications, cold medications, injections, and temporarily prescribed medi-

cation, including all over the counter medications, vitamin/mineral supplements, nutritional supplements, herbs, homeopathic remedies, other

treatments, etc. that camper is currently taking. Administration advice is greatly appreciated. If camper will not be taking medications, etc. at

camp, but takes them routinely, at other times, please list what is taken and in Comments section, please mention that they won’t be taken at

camp.

Medication Correspondence Contact Name: ___________________________________________ Relationship to Camper: ______________________________

E-mail: ________________________________________ Primary Phone: ( ) __________- _________________ Secondary Phone: ( ) __________- _________________

Correspondence Contact Address: ________________________________________________________________________________________________________-___________

Medications will be dispensed at B-Breakfast, L-Lunch, D-Dinner, HS-Hour of Sleep unless otherwise specified below under

“Comments or Special Instructions” section.

·If a medication is used for sleep purposes or will make camper very drowsy at bedtime, please mark it as HS as opposed to a specific time, as

bedtime at camp is not necessarily your camper’s normal bedtime.

·If medication needs to be dispensed at a specific time (for pain, blood pressure, blood sugar, or seizures, for instance), please make sure to list

specific time/s medication is to be administered as opposed to using approximations (B, L, D, HS); make sure to use the comment section.

Each item listed must include accurate name, strength, dosage, times, and comments/instructions as necessary. The following page will have a

continuation of this form, for your convenience; if you need more lines/space, please go online to print the form or make a copy of the pages.

Last First Middle

Camper Name: _______________________________________________________________________________________

Name of Medication Strength of Each Individual Pill and Route

Dosage At Each Time

Times use B, L, D, HS

if possible

Comments or Special Instructions crushed, with food or how medication is given at home

side effects, history of refusal or hiding medication

Ibuprofen - 200 mg, oral *Pill = Ibuprofen *Strength = 200 mg *Route = oral

200 mg B

200 mg L

100 mg @4:30 PM

100 mg HS

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

N/A <- Please check box if camper takes no medication, supplements, OTC remedies, etc.

Take with food and plenty of water.

Take 30 minutes before meal; take on empty stomach.

Split 200 mg tablet in half, crush, mix with pudding.

Split 200 mg tablet in half & take with water, might refuse.

<- Please check box if camper has a DNR (Do Not Resuscitate) order in place. Please provide a copy for camp.

Page 7

Last First Middle

Camper Name: _______________________________________________________________________________________

Name of Medication

Strength of Each Individual Pill and Route

Dosage

At Each Time

Times

use B, L, D, HS

if possible

Comments or Special Instructions

crushed, with food or how medication is given at home

side effects, history of refusal or hiding medication

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

CONTINUATION OF PAGE 4

Take with food and plenty of water.

Take 30 minutes before meal; take on empty stomach.

Split 200 mg tablet in half, crush, mix with pudding.

Split 200 mg tablet in half & take with water, might refuse.

***Please update camp whenever there is a change in medication and medical information.***

MOBILITY &

POSITIONING

*** Please check which best applies ***

Comments:

- uses wheelchair yes no manual electric

- bears weight yes no yes, with assistance

- transfers alone assistance

- list additional adaptive equipment for

mobility (walker, cane, braces, etc.):

- additional mobility comments (also list any restrictions on mobility):

Page 8

COMMUNICATION

(verbal, sign language, device, gazes)

Please check

Yes or No

Comments:

-verbal

- uses sign language

- uses communication device **please bring device**

- uses eye gazes (glances/shifts eyes towards)

- list key/special words or phrases used at home

BEHAVIOR CONCERNS

*** answers will NOT exclude individual, but

will ensure the best possible care ***

Please check

Yes or No

Comments:

- shows aggression toward others

- shows aggression toward self

- describe any negative behaviors

- describe helpful behavior

strategies/interventions

- has been restrained

*** If yes, list when and summarize the circumstances on the line below ***

- additional behavior information:

SWIMMING

(shallow, deep, equipment)

Please check

Yes or No

Comments:

-swims independently in shallow end

- swims independently in deep end

- submerges head under water

- enters pool without assistance

- comments concerning swimming, restrictions:

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

Last First Middle

Camper Name: ______________________________________________________________________________________________

Last First Middle

Page 9

FEEDING

(eating & drinking)

Independent Needs Verbal

Prompts

Needs Physical

Assistance

Comments:

- eats

- drinks

- needs special positioning/equipment describe/list:

HYGIENE

(shower, shampoo, brush teeth)

Independent Needs Verbal

Prompts

Needs Physical

Assistance

Comments:

- takes a shower

- shampoos hair

- dries off

- brushes teeth

- needs special positioning/equipment describe/list:

NIGHTTIME ROUTINE

check box & provide details

Please

check

Yes or No

Comments:

- sleeps through the night

- has special sleep habits

(list camper’s sleep habits, if any)

- has sleep positioning requirements

(photos are greatly appreciated)

- has history of wetting or soiling bed

(send extra bedding and/or bed pads)

TOILETING

check box & provide details

Independent Needs Verbal

Prompts

Needs Physical

Assistance

Comments:

- uses toilet appropriately

- asks to use the toilet

- wipes well

Camper Name: _____________________________________________________________________________________________________

UNPACKING/PACKING

& DRESSING

Independent Needs Verbal

Prompts

Needs Physical

Assistance

Comments:

- unpacks/packs self

- undresses/dresses self

- has catheter N/A describe:

- wears absorbent briefs N/A describe:

- uses adaptive equipment? N/A describe:

- has bathroom schedule N/A describe:

Page 10

MM / DD / YYYY

Initials: _______ Photo Release: I hereby give consent for participant to attend and participate in all programs and activities of Central Oklahoma Camp and the

Make Promises Happen program. Pictures, audio tapes and videotapes may be taken of participant for use in publicity that is in the proper inter-

est of Central Oklahoma Camp and the Make Promises Happen program. I will alert COC&CC/MPH staff if camper is in state custody and can-

not be photographed, due to lack of consent or other reasons.

Initials: _______ Field Trips/Transportation: I understand that the program may include not only normal activities conducted at Central Oklahoma Camp, but may

also include field trips and multi-day trips which may require transportation to and from locations, and trips which will involve walking and hiking

away from Central Oklahoma Camp. I hereby give permission for participant to participate in any and all such activities, which are super-

vised and deemed appropriate by qualified camp personnel.

Initials: _______ Activities: I understand that participant may take part in activities on the campground that could include a climbing wall, ropes course training,

archery, swimming, canoeing and other such activities of Central Oklahoma Camp and the Make Promises Happen program. I do hereby agree to

indemnify and hold Central Oklahoma Camp and the Make Promises Happen program and its agents, servants and/or employees harmless from any

and all damages, claims, expenses or costs of whatever nature, causes of action, suits and liability of every kind including attorney fees, for injury to or

death of participant or for damages to any property, arising out of or in connection with participant's use or occupancy of the premises or participation in

activities at Central Oklahoma Camp and the Make Promises Happen program, except where such injuries, misfortune, accident, or damages are

caused in whole or in part by the negligence of Central Oklahoma Camp and the Make Promises Happen program, or joint negligence of any

person or entity hired or contracted by Central Oklahoma Camp and the Make Promises Happen program.

Initials: _______ Cancellation of Participation: I understand that if I have misrepresented or failed to inform Central Oklahoma Camp and the Make Promises

Happen program of any special needs or disabilities that participant has, that Central Oklahoma Camp and the Make Promises Happen program may not

be able to provide appropriate support. If this situation occurs, I understand and agree that Central Oklahoma Camp and the Make Promises Happen

program will terminate participation in the program and I understand and agree that if participant must leave program because of un-

disclosed issues that no money will be refunded to me.

Initials: _______ I hereby give my permission for Certified Medication Administration staff to give medication to the camper

while at camp or recreation program. The health history is correct and accurately reflects the health status of the camper to whom it pertains. The

person described has permission to participate in all camp activities except as noted by me and/or an examining physician. I give permission to

the health care provider selected by the camp to order x-rays, routine tests, and treatment related to the health of my child for both routine health

care and in emergency situations. If I cannot be reached in an emergency, I give my permission to the health care provider to hospitalize, secure

proper treatment for, and order injection, anesthesia, or surgery for this camper. I understand the medical information provided will be shared on

a "need to know" basis with camp staff. I give permission to photocopy the packet. In addition, the camp has permission to obtain a copy of my

camper’s health record from providers who treat my camper and these providers may talk with the program’s staff about my camper’s health

status. I understand that I will be contacted, at the emergency numbers listed on the registration form, by the camp staff once emergency medical

treatment has been secured.

Initials: _______ Cancelation Policy: I understand that refunds and/or deposit credits will only be applied if notification is given to camp office at least 1 week (7

days) prior to the event.

Initials: _______ E-mail Communication: I understand that my name will be added to a web service in order that I will receive communications via E-Mail, if I

provided an E-Mail address for communication purposes (fundraising, camp calendar and registration of events, etc.). I understand that I can alter

my subscription from the web service at any time, that it is my responsibility to update the camp with any changes to my contact information, any

information that I provided.

Initials: _______ Sharing of Information: I give Central Oklahoma Camp and Conference Center/Make Promises Happen permission to share my name and con-

tact information with support groups, agencies and organizations, camper families. I understand that camp will not share sensitive information, such

as diagnosis, medical, financial, etc. Furthermore, I understand that the purposes of sharing the information would be to provide support to other

campers, their families and guardians, and for returning any missing items that went home with another camper.

The camper and the guardian shall protect, hold free and harmless, defend and indemnify Central Oklahoma Camp & Conference Center and the Make Promises

Happen program (including its officers, agents, volunteers and employees) from all liability, penalties, costs, losses, damages, expenses, causes of action, claims or judg-

ments (including attorneys' fees and/or fines and penalties) which arise out of, or are in any way connected with the performance of the work and/or services provided

under this contract. This agreement shall apply to any acts or omissions, negligent conduct, whether active or passive, including acts or omissions, injury, damage

and/or loss of property and misfortune or accident on the part of named child or their agents and/or representative. EXCEPT that this agreement shall not be appli-

cable to injury, misfortune, accident or damage to property arising from the sole negligence of Central Oklahoma Camp & Conference Center and the Make Promises

Happen program, its officers, agents, volunteers and employees.

Signature of Legal Guardian/Agent Acting on Behalf of the Legal Guardian: Date:

_______________________________________________ ____________________

Legal Guardian or agent for camper, must initial each section and sign and date below as indicated.

When necessary, oral consent may be given, witnessed, noted and signed accordingly.

Last First Middle

Camper Name: _________________________________________________________________________________________________

Please return completed Paperwork to: Make Promises Happen, #1 Twin Cedar Lane, Guthrie, OK 73044-7041

Help camp staff get to know your camper and provide any additional

information about him/her in the box provided.

Last First Middle

Camper Name: ______________________________________________________________________________________________

For your own protection and convenience, please make a copy of each of the pages, all paperwork you submit to camp.

Please use the checklist provided below, checking the boxes below to ensure you have included all

information, prior to submitting your camper’s MPH Camp Registration paperwork.

REMEMBER:

There is NOT a reservation for your camper’s MPH camps until ALL necessary criteria have been met:

Completion of all preceding pages, with all pages completely filled out, dated, signed

Supplemental paperwork, if necessary, which may include, but is not limited to:

1) a MARS in lieu of medication page/s, with times of medication administration listed

2) a copy of an older physical, within the previous year, awaiting the current year’s physical with a note stating that the required

physical will be completed and sent on a specified date prior to camper’s arrival to camp, or a current physical from

Special Olympics, the doctor’s office, DHS annual that will be completed as described above

3) a copy of camper’s DNR and any instructions, if applicable

4) if using waivered services or a voucher as payment, a payment via Acumen or via Voucher letter

5) if the required deposits are not included, a proposed Payment Plan and/or Scholarship Request and any supporting documents

6) a copy of insurance cards, if camper has insurance

7) a copy of camper’s behavior plan, if applicable

8) any pictures showing positioning for feeding, sleeping, etc.

9) any beneficial information concerning camper’s day to day, daily living, likes/interests

A current head/shoulders picture of the camper (e-mail to heather@centralokcamp.org) or text it to 405-471-7965.

If you send a picture via USPS, and would like it returned, please provide a self addressed, stamped envelope.

The correct amount for deposits, and/or an amount agreeing with your proposed Payment Plan