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Ben James Summer Camp General Application
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* Indicates required question
Camper Full Name:
*
Your answer
Camper Age:
*
Your answer
Have you ever attended a Ben James Summer Camp before?
*
Yes
No
Not Sure
Residence:
*
Family Home
Residential Home
Foster Home
Other
How do you identify with regards to autism?
*
Autistic
Person on the spectrum
PDD-NOS
Aspergers
No formal diagnosis/self diagnosed
Not sure
Other:
Do you require support staff additional to our 1:1 counsellor?
*
Yes
No
Contact Person:
*
Your answer
Contact Phone Number:
*
Your answer
Contact Email Address:
*
Your answer
Are there any dates in July or August that you would not be available to attend camp?
Your answer
Which location do you prefer?
*
Dartmouth
Halifax
Doesn't Matter
T-shirt size:
*
Youth XS
Youth S
Youth M
Youth L
Youth XL
Adult XS
Adult S
Adult M
Adult L
Adult XL
Adult XXL
Would you be interested in an additional week of camp?
*
Yes
No
Is there any other additional information you think would be helpful for us to know?
Your answer
I understand that this application form does not guarantee my spot in the Ben James Summer Camp
*
I understand!
Required
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