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Summer Day Camp Application

Parent Information

Camper Information

Functionality Rating Scale FRS Scoring Instructions: Please indicate the level of instruction or ability for the child. Comments section is to be used for further details or explanations.

Body Movement
Feeding Assistance
Toileting Assistance
Level of Functioning
Interations with others
Supervision for Public Outing
Communication Ablitiy

Step 1: Submit Application

Step 2:  Send $25.00 Refundable Registration fee 
by PayPal to Hart of Autism

*Refunded if attend all 3 days of camp

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