Camp Connect Intake Assessment

This information will be used to pair your child with a Buddy, whom your child will be with the entirety of the week of camp (given there are no unforeseen circumstances). Your child’s assigned Buddy will review this information before meeting your child. All camp Buddies are Master’s level counseling students and will have participated in an intensive TBRI camp training. Please include as much detail as possible for us to ensure the best experience for your child and their Buddy. All information will be kept confidential between camp Buddies and staff. 

Parent/Guardian *
Parent/Guardian
Phone *
Phone
Child's Name *
Child's Name
Name of sibling(s) also attending camp:
Name of sibling(s) also attending camp:
How often do these intensive/aggressive behaviors occur?
Have you noticed the child may have a specific preference regarding interaction with others?
How would you describe the parenting style (structure/routine/rules/expectations) of the household? (Choose one):
Please check the following items as your acknowledgement of camp information/requirements.
Primary Emergency Contact Name:
Primary Emergency Contact Name:
Primary Emergency Contact Phone:
Primary Emergency Contact Phone:
Secondary Emergency Contact Name:
Secondary Emergency Contact Name:
Secondary Emergency Contact Phone:
Secondary Emergency Contact Phone: