Culinary Program Summer Camp Application - End Hunger in Calvert County

Camper Information

Prospective Camper Name*

First Middle Last

Gender*

Male

Female

Date of Birth*

MM slash DD slash YYYY

Parent/Guardian Name*

First Middle Last

Email*

Primary Phone*

Preferred Contact Method*

Phone

What county do you live in?*

Anne Arundel

Calvert

Charles

Prince George's

St. Mary's

How did you hear about the Culinary Training Program's Teen Summer Camp?*

Family/Friend/Word of Mouth

Social Media

Community Agency

Other

Disability Information

Please list and describe camper's disabilities, beginning with your primary disability.

Disability #1: What is the disability?*

Disability #1: Date of Onset*

MM slash DD slash YYYY

Disability #1: This disability is a result of:*

Disability #1: How does this disability limit camper's independence?*

Disability #2: What is the disability?

Disability #2: Date of Onset

MM slash DD slash YYYY

Disability #2: This disability is a result of:

Disability #2: How does this disability limit camper's independence?

Disability #3: What is the disability?

Disability #3: Date of Onset

MM slash DD slash YYYY

Disability #3: This disability is a result of:

Disability #3: How does this disability limit camper's independence?

Additional Comments

Education

What is the highest level of education your camper has completed? (Select one)*

No Formal Schooling

Elementary School

Secondary School

Some High School

High School Certificate of Completion

High School Diploma

GED

Name of High School

If applicable.

Are you willing to provide a copy of your camper's most recent IEP and/or 504 Plan? (select one)*

Yes

My Camper doesn't have this documentation.

Please describe why your camper is interested in participating in The Culinary Program’s Teen Summer Camp experience?*

Transportation

Does your student have reliable transportation arranged for each day of camp?*

Yes

Physical Health History

Are you able to stand for at least 2 consecutive hours at a time?*

Yes

If no, please explain.

Please describe any medical conditions (Seizures, Asthma, etc.)*

Do you have food allergies?*

Yes

If yes, please list:

Any other physical conditions or needs that we should be aware of?

Camper Attributes for Success

Personal

Maintains good personal hygiene.*

Yes

Communicates with others and expresses needs clearly.*

Yes

Additional Information:

Handles changes in routine and shows flexibility in fluctuating circumstances.*

Yes

Additional Information:

Social & Emotional

Shows self-regulation and avoids inappropriate outbursts.*

Yes

Additional Information:

Respects self and others.*

Yes

Additional Information:

Works well in a team and individually.*

Yes

Additional Information:

Manages mild stress (e.g. time demands, constructive criticism and coaching)*

Yes

Additional Information:

Cognitive

Functions well in kitchen and classroom learning environments.*

Yes

Additional Information:

Understands basic instructions and carries out those instructions, with low to moderate supervision.*

Yes

Additional Information:

Comprehends written text at a 5th grade level.*

Yes

Additional Information:

Reads and follows basic recipes and directions, including the transfer to action.*

Yes

Additional Information:

Ability to understand and follow safety protocols.*

Yes

Additional Information:

Reasoning sufficient to understand constructive criticism*

Yes

Additional Information:

Vocational

Has the desire and motivation to participate in a pre-vocational educational experience.*

Yes

Willing to learn about and use commercial kitchen equipment such as mixers, stoves, and ovens.*

Yes

Payment

Total Camp Cost: $400

Payment Breakdown:

$100 non-refundable deposit due upon Acceptance

Full Balance Due by June 14

*Limited number of need-based scholarships available upon request

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.

Culinary Summer Camp Application

Camper Information

Disability Information

Education

Transportation

Physical Health History

Camper Attributes for Success

Personal

Social & Emotional

Cognitive

Vocational

Payment

Total Camp Cost: $400

Payment Breakdown: