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Join Us
Who We Are
About Arc
Board Members
Leadership
Publications
Quality & Compliance
News & Press
Join Our Team
What We Do
Day Services
Residential Services
Horizons Clinic
Respite and Recreation
Employment Supports
Community Habilitation
Family Support Services
Contract Services
Get Involved
Family Advocacy
Become a Member
Annual Appeal
Sensory Garden
Planned Giving
Legacy of Love
Volunteer
Butterfly Gallery
Resources
For Parents and Guardians
For More Information
Events
Sponsorship
Arc Race
Gala
Contact Us
Camps And Art Surge Application
Applicant Information
Child Name
Child DOB
OPWDD Eligibility Status
Select Option
Permanent
Provisional
Unsure
TABS # (If Applicable)
Parent/Guardian Name
Parent/Guardian Phone
Parent/Guardian Email
Care Manager (If Applicable)
Care Manager Phone
Care Manager Email
Program Of Interest
Program Of Interest
Art Surge
Integrated Camp Support
If interested in camps, what camp(s) were you interested in?
Camp Dates
Are you registered yet?
Yes
No
Support Needs
Mobility
Independent
Physical Assistance
Walker
Wheelchair
Medical Needs
Seizure Disorder
Insulin Monitoring
Medication administration
Allergies monitoring
Other
Dining Needs
Independent
Some assistance
Total support
Choking risk
Food allergies
Toileting Needs
Independent
Some assistance
Total support
Behavioral Concerns
Emotional Outbursts
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
Self-Injurious
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
Aggression To Others
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
Property Destruction
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
Elopement
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
PICA
Select Option
Not Applicable
Not This Year
Occasionally Less Than Once A Month
Monthly About Once A Month
Weekly About Once A Week
Frequently Several Times A Week
Daily Once A Day Or More
Please elaborate on any behavioral supports
Please Attach
Letter of Eligibility
Life Plan (If Applicable)
Self-Directed Budget (If Applicable)
Submit