Camp ABLE Registration Request

Camp ABLE is a full day/all summer camp. We do not offer half-days or partial summer enrollment. Children attending ESY (summer school) are not eligible to attend.

Child's Name

First

Last

Gender

Male
Female

Date of Birth

Age

Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian Name

First

Last

Phone 1

Phone 2

Child's Developmental Disability for Services

Eligibility Requirements for Services

Applicants must meet all requirements below.

Check all that apply:

Child is between the ages of 2 and 21 years.
Child is enrolled in Broward Public School program (or McKay Scholarship Program) leading to HS diploma or equivalent.
Child resides in Broward County with natural or foster family.
Child has a diagnosis of Developmental Disability (documentation of such will be required).
Child is medically stable and does not require skilled nursing care.
Child can be transported in a non-handicap accessible 12-passenger van safely.
Child will be in attendance on a regular basis for full term (8 weeks).
Child has been denied enrollment or has been dis-enrolled from after-school/out-of-school programs due to his/her moderate-to-severe maladaptive behaviors.

Please list ALL current and prior after-school/out-of-school and summer programs your child has participated in during the past three years and reasons for dis-enrollment, if applicable:

Child displays behaviors that result in one or more of the following:

Harm or potential harm to child or others.
Interference with child's adaptive skills and routines and/or learning opportunities.
Damage/harm to property or animals.
Disruption to environment/others.
Violation of acceptable social norms or rules.
Violation of law.

Describe specific behaviors from the question above.

Acknowledgement

I understand that camp is a full-time program and confirm that, if enrolled, my child will attend camp full days each week that camp operates.

Camp ABLE Registration Request

Eligibility Requirements for Services

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