Register For Apraxia Camp (CAMP BEE!)

Please enable JavaScript in your browser to complete this form.

Camper's Name: *

First

Last

Camper's Date Of Birth: *

Camper's Gender/Pronouns: *

What size shirt is your camper? *

Who will be traveling with the camper to camp? *

Please provide the best contact information and mailing address for those traveling with the camper: *

Who will be dropping off and picking up your camper? Please provide their name(s) and contact information: *

In case of an emergency, who should we contact, and what is the best phone number? *

Parent(s)/Caregiver(s) Name(s): *

Parent/Guardian Email: *

Parent/Guardian Phone: *

Is your camper in school? If so, what grade are they in? *

If your camper is not in school yet, please enter "N/A."

If your camper is in school, do they have an IEP or 504 plan?

If your camper has an IEP or 504 plan, would you be willing to share the most recent version with our coordinating partners, Jordan LeVan and Mikayla Treynor, to help us better support your child?

Is the camper’s primary language English? If not, please list all languages spoken: *

Does the camper have a childhood apraxia of speech (CAS) diagnosis? *

Yes
No
Suspected

Please list all areas of disability: *

(Note: As an anti-ableist camp, we welcome children with diverse disabilities. Understanding your child’s needs helps us provide comprehensive support.)

Does the camper have any medical conditions/diagnoses we should be aware of (e.g., allergies, asthma, seizures, etc.)? If yes, please list their condition(s), any required medications, and emergency protocols: *

Does your camper have any dietary restrictions? *

Does your camper have sensory sensitivities, phobias, or preferences (e.g., noise, texture, lighting, etc.)? If yes, how can we accommodate them? *

Does your camper have any physical needs or mobility challenges that require accommodations? *

If you answered "yes" to your camper needing accommodations, please list them here:

Is your camper aware of their disability? *

Yes
No
Not sure

How would you describe your camper’s personality? *

How would you describe the quality of your camper’s social relationships? Do they face challenges making new friends? *

Does your camper experience frustration related to their speech difficulties? *

If yes, how does this frustration typically manifest? (For example: If internalized, they may emotionally shut down. If externalized, they may hit, throw, cry, scream, etc.) *

If applicable, what strategies or interventions have been tried to support your camper during these times? Please list what has worked and what has not. *

How does your camper prefer to communicate (e.g., verbally, AAC, gestures, etc.)? (Check all that apply) *

High Tech Speech Generating Device
Mid Tech Speech Generating Device
Low Tech Speech Generating Device
Verbal Speech
Picture Exchange Communication System (PECS)
Gestures
American Sign Language (ASL)
Other

Does your camper use a Speech Generating Device? If so, please provide the device model, application used, and any accessibility features.

Has an AAC evaluation been conducted? *

If an AAC evaluation has not been conducted, would you like your camper to receive an AAC evaluation during the camp?

Yes
No
Unsure at this time

If you would like an AAC evaluation, please email your contact information and insurance to mikayla@sandyspeakstherapy.com.

What helps your camper self-regulate during moments of frustration or overstimulation (e.g., specific items, routines, strategies, etc.)? *

Please share your camper’s interests, hobbies, and activities they enjoy: *

any Mikayla setting,

What are your goals for your camper while attending Camp BEE? *

Does your camper currently receive speech therapy? If so, is it provided in a private setting, school setting, outpatient, or through early intervention services? *

Private/Outpatient Setting
School Setting
Early Intervention Services
Currently not enrolled in speech services

Do you give Camp BEE staff permission to collaborate with your child's SLP(s)?

If you clicked "Yes," please provide the contact information for your child's SLP(s):

Would you like your camper to undergo a speech and language evaluation during the camp? *

Yes
No
Unsure at this time

Are there specific areas of need you would like us to prioritize for speech intervention during the camp? *

How is your camper’s support system (e.g., family, friends, teachers, therapists, etc.)? *

Are you willing to meet with our managing partners, Mikayla Treynor and Jordan LeVan, via Zoom before camp to discuss your camper’s needs? *

Are you willing to provide feedback after the camp to help us improve future camps/programs? *

Do you consent to photos or videos of your camper being taken during camp for internal or promotional purposes, such as social media marketing? *

Payment Preference: Would you like to pay in full ($1,200 for Early Bird or $1,400 for Regular Admission) or utilize the split payment option (50% upfront and 50% four weeks later)? *

Pay In Full
Split Payment

See the "Permission & Agreement" form below for full details regarding payment.

Permission & Agreement *

I agree and give my permission

Camp Building Empowered Expression (BEE) Permission and Agreement:

By completing this application form, you confirm that all information provided regarding the camper, parents/guardians, and individuals authorized for pick-up and drop-off is accurate and truthful to the best of your knowledge.

Camp Fees and Payment Policies:

The cost for Camp BEE from January 1–31, 2025 (Early Bird Special) is $1,200.

The cost for Camp BEE from February 1–28, 2025 (Regular Admission) is $1,400.

Upon agreeing to this form, you acknowledge the following payment terms:

Once your application is reviewed and approved, you will receive an invoice via QuickBooks.

Payment is due upon receipt of the invoice.

If you choose the split payment option:

50% of the total fee is due within 7 business days of receiving the first invoice.

The remaining 50% is due four weeks later, within 72 hours of receiving the second invoice.

Failure to pay the second invoice within 72 hours will result in the forfeiture of the camper’s spot at Camp BEE. The initial 50% payment will not be refunded.

By agreeing to this Permission and Agreement, you confirm your understanding and acceptance of Camp Building Empowered Expression, LLC’s policies, including the non-refundable nature of the initial 50% payment if payment deadlines are not met.

Acknowledgment:

By consenting to this agreement, you:

Confirm that all information provided is accurate.

Acknowledge and accept the camp fees, payment terms, and refund policies.

Agree to comply with Camp BEE’s procedures and guidelines.

Thank you for choosing Camp Building Empowered Expression (BEE). We look forward to welcoming your camper!

Footer

Subscribe!