Camper
Profile
Form
Is your information accurate?
If NOT – please provide
corrections!
\NOTE: This is the ONLY confirmation provided
for your cabin-mate request! “NA” or an empty
blank indicates she does not have one.
Please complete, sign, and mail in this form to our camp office by April 15th.
This form helps cabin counselors get to know your daughter before she arrives at camp.
The more we know, the better we take care of your child.
Additional Camper Information:
Age by June 1, 2016
School Attending
Family Information:
Parents are: MARRIED
Height
Weight
Religious Affiliation (optional)
Name of Brother/Sister
LEGAL PARTNERS
DIVORCED
Age
Custody: JOINT
SEPARATED
Camper History: Has attended sleep-away camp?
Current School Grade
MOTHER
FATHER
Years at Birchwood:
Camper’s attitude towards past camp experiences:
Number of experiences away from home (circle):
A LOT
Camper’s ability to adjust new situations & people (circle):
Health Concerns: Regarding menstruation (circle):
Alternative Dietary Needs: VEGETARIAN
A HANDFUL
EXCELLENT
HAS HAD FIRST PERIOD
LACTOSE INTOLERANT
HARDLY ANY
GOOD
FAIR
NONE
HAS DIFFICULTY
MAY HAVE FIRST PERIOD AT CAMP
GLUTEN INTOLERANT
N/A
NUT ALLERGY
OTHER FOOD ALLERGIES/INTOLERANCES:______________________________________________________
Alternative dietary options require prior arrangements, and an additional charge will be applied to your daughters store account.
Sleeping habits/concerns (bed wetting, sleep walking, night terrors):___________________________________________
Pertaining to Camp:
Camper’s attitude about attending Birchwood (circle):
Activities camper is looking forward to doing:
Camper’s expectations/goals for camp experience:
Parent’s expectations/goals for camp experience:
ENTHUSED
HESITANT
UNENTHUSED
Any particular concerns/issues camper has that may affect her behavior at camp:
About Your Camper:
Activities/Hobbies/Interests:
Favorite things to talk about:
In talking & relating to others she:
Participates in group activities:
SHARES EASILY
EASILY
IS SHY
TENDS TO OVERSHARE
WHEN ENCOURAGED
NEEDS TO BE INVITED
WITH RELUCTANCE
HARDLY EVER
How your child deals with conflict:
What kinds of things comfort your camper or put her at ease?
If your child has a problem, concern, difficulty (emotional or physical) how does she express it?
What are ways that your daughter’s cabin counselors can help her deal with a problem if she has one?
ONE ON ONE CONVERSATION
TIME TO COOL OFF
PROVIDE AN ACTIVITY TO KEEP HER BUSY ( EX: fun craft project)
RELAXING MUSIC
SHORT WALK
JOURNALING
INITIATE A GROUP ACTIVITY
OTHER: ________________________________________________________________________________________________________________
Camp Readiness: Parents - please review & check-off these issues with your camper (see the Parent Handbook).
My camper understands that she will be expected to follow the camp rules during her stay.
My daughter knows that cell phones, eReaders, Ipods w/ internet access, etc. are not allowed in camp.
__ My daughter understands that camp is not responsible for any damage to personal belongings.
My camper is prepared to treat others with kindness and respect (not tease, bully or “put down” others).
My camper will take responsibility for her own hygiene on a regular basis (brush teeth, wash hair, etc).
My camper understands the importance of applying sunscreen and bug spray and will do so at camp.
My daughter is prepared to keep her space tidy & assist others with cleaning the entire cabin.
If something feels very uncomfortable, unsafe, or unfair, my daughter is prepared to go to an adult for help.
Additional Comments to Counselors:
Participation Permission
By signing this form, I permit my child to participate in all camp activities, including horseback riding, climbing, and
wilderness activities away from camp. I also give Camp Birchwood permission to transport my child and to use
photographs and video of my child for advertising and promotional purposes.
Signed:
Date: