2023 Specialized Adventures Camp Application 

*CAMP REGISTRATION IS NEARLY FILLED*

Please complete this application to either grab one of our final spots or to be on our camp waitlist. We are constantly moving folks up from the waitlist so AND folks on the waitlist get informed first when next year's camp registration opens!

Get ready for some summer fun!

Specialized Adventures Camp is located on the main campus of Glade Run Lutheran Services in Zelienople, Pa.

Specialized Adventures Camp is for children ages 8-18 in need of social skill development.

Camp is specially designed for campers with diagnosis on the Autism spectrum, but all abilities are considered for camp.  

Camps run 9:00 am till 3:00 pm.  Daily lunch and transportation are not provided by Glade Run Adventures.

For more information, call (724) 452-4453 ext. 1236  or email JWahlenmayer@gladerun.org


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Email *
Camper's First Name *
Camper's Last Name *
Has this camper attended camp in the past?
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Session Choice(s) *
Camper's age at the start of camp *
Camper's Weight *
Camper's T-Shirt Size *
Parents/Guardian Name(s) 
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Parent/Guardian email address 
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Cell Phone Number(s) 
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Emergency Contact (other than parent/guardian) 
Name, relationship and cell phone number
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Please list any allergies or medical concerns for this camper. *

Does your child have seizures? 

*All campers with seizure precautions require medical history clearance from physician for mounted activities* 

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What clinical diagnosis/es, if any, has this camper been given? *
Please describe this camper's behaviors (including any significant acting out, ritualistic, or self-stimulating behavior).     
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Will your camper be attending with a Therapeutic Support Staff? 
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Will this camper require medication during camp hours?  
* If child takes medication during Summer Camp hours, written instructions must be submitted at the start of camp with the medication in a sealed Ziploc bag.  Staff will not administer medication.  Child must administer their own medication, with staff monitoring.*
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Does this camper display any of the following;
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Required
How does this camper get along with other children? 
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How does this camper get along with adults? 
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What are triggers for this camper?
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What can you suggest that might distract or redirect this camper from inappropriate behavior? 
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Please share any concerns or other specific information that you feel will help the staff to better provide a beneficial experience for your child in summer camp. 
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