1:1 Program Needs & Assessment Application

Camper Name:

Date of Birth:

Camp age limits for children and youth in the One-on-One program are 4-12 years. Campers must be 4 years old by December 31st of the current camp season.

Caregiver Name:

Caregiver Email:

Caregiver Phone Number:

Communication (verbal vs. non-verbal)

Briefly Describe your Camper's Personality. What are their Interests?

Are there any personal development goals your camper is working towards, that you would like to make known to camp staff? Does you camper have any counsellor group or sport goals for this summer?

Eye Contact:

Awareness of peers (personal space, feelings, etc.):

How are they with introductions (to peers, to support staff, etc.):

Self-esteem:

How would you describe the camper's confidence level? Do they have an ability to engage with peers, and new environments?

Frustrations:

What are the causes, signs, and strategies?

Outbursts or aggressions:

What are the causes, signs and strategies?

Anxieties:

What are the causes, signs, and strategies?

Excitement/happiness:

What are the causes, signs, and strategies?

Ability to follow directions and instructions:

Response to negations or "no":

Does your child have a known diagnosis or in the process of seeking diagnosis??

Washroom (handwashing, able to wipe, undress and redress):

Support with clothing up/down
Support with cleaning
Assistance hand washing
New environmental washrooms
- Auto-flushing toilets

Mobility (indoors, outside, stairs, etc.):

Camper Experience:

Have they attended any camps in the past? If so, which ones?

Sensory needs or sensitivities (noise, light, textile, etc.):

Comprehension (ability to understand instructions):

Memory (remembering to drink water, put on sunscreen, etc.):

Water games/Swimming (interest, ability, experience, devices, etc.):

Dressing (changing for water games/swimming):

Able to use the washroom independently?

Eating (snack and lunch time):

Use of assistive devices (walkers, visuals, braces, communications, tech/iPads, etc.):

Behaviour management strategies:

Please let us know what techniques you use to relax your child? Ie. watching cat videos on YouTube, playing with stuffed animals, etc.

Would your camper be attending camp with any siblings or friends? Please list their name(s) to include in the support network if desired:

Is there anything else we should know to best support your camper? (Dietary related concerns, health history, medications, etc.):

Waitlist Option

We are currently wait-listing for all weeks and will reach out only if a space becomes available

Week 1 and 2

June 29 - July 10

Week 3 and 4

July 13 - July 24

Week 5 and 6

July 27 - August 7

Week 7 and 8

August 10 - August 21

All Available Weeks

Comments: If there is any additional information you’d like to share regarding session dates, camp options, please share here)

If your camper has an Individual Educational Plan (IEP) that has been developed elsewhere that you would like to share with us, please upload it here.

One file only.
20 MB limit.
Allowed types: jpg, png, gif, tif, svg, bmp, txt, pdf, doc, docx, xls, xlsx, mp3, ogg, wav, rtf, odt, ppt, pptx, odp, ods.

1:1 Program Needs & Assessment Application

Find information for...

Future Students

Current Students

Indigenous Students

International Students

Alumni

Industry and Employers

Parents and Caregivers

Athletes ⤻

Educators

Donors and Supporters

Community

Media

Careers at Mohawk

Employees

Mohawk College