Camp Sunshine & Little Sunshine 2025

Camper Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender *

Female

Male

Is your child potty trained? *

Yes

No

Does your child elope? *

Elopement refers to when an individual, often with a developmental disability like autism, unexpectedly leaves a safe area or caregiver's supervision without permission, essentially "running away" or wandering off, which can pose a significant safety risk due to potential for getting lost or injured; it's often used interchangeably with "wandering" in this context.

Yes

No

Doctor's Phone Number *

(###)

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Does your child receive CAP or 1-on-1 services? *

Yes

No

Parent/Guardian Name 1 *

First Name

Last Name

Parent/Guardian Address 1 *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Primary Phone 1 *

(###)

###

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Parent/Guardian Secondary Phone 1

(###)

###

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Parent/Guardian Employer Phone 1 *

If none, enter your primary phone number again.

(###)

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Parent/Guardian Name 2 *

First Name

Last Name

Parent/Guardian Address 2

Please enter if different from Parent/Guardian Address 1

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Primary Phone 2

(###)

###

####

Parent/Guardian Secondary Phone 2

(###)

###

####

Parent/Guardian Employer Phone 2

(###)

###

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Emergency Contact Phone *

(###)

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Emergency Contact Preference *

In case we need to reach a parent/guardian or emergency contact during the day, please let us know who we should attempt to contact first. Please note, if we are unable to get in touch with parents and emergency contact OR failure to retrieve your child will result in an immediate dismissal from camp and your child will be unable to attend camp in the future.

Contact Parent(s)/Guardian(s) first

Contact Emergency Contact first

Do you plan to use your innovation waiver to cover the cost of camp? *

If you are using an innovation waiver to pay for camp, you will need to reach out to us at operations@arcofwilsonnc.org or (252)2377-8266 so we can work with you to get that process started, as quickly as possible.

Yes

No

N/A