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2023 Culinary Summer Camp Application

by Greg Dietrich | May 8, 2023

2023 Culinary Summer Camp Application

Step 1 of 2

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CAMPER INFORMATION

Name(Required)

First Middle Last

Phone(Required)

Email(Required)

Gender(Required)

Male

Female

Date of Birth(Required)

Month

Day

Year

How did you hear about the Culinary Training Program's Teen Summer Camp?(Required)

DISABILITY INFORMATION

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

1. Disability

Date of onset

Month

Day

Year

This disability is a result of:

How does this disability limit camper's independence?

2. Disability

Date of onset

Month

Day

Year

This disability is a result of:

How does this disability limit camper's independence?

3. Disability

Date of onset

Month

Day

Year

This disability is a result of:

How does this disability limit camper's independence?

EDUCATION

What is the highest level of education your camper has completed?(Required)

No Formal Schooling

Elementary or Secondary School Grade

High School

GED

Grade(Required)

Please enter a number from 1 to 9.

Name of High School:(Required)

Untitled

Certificate of Completion

High School Diploma

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

Yes

No

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?(Required)

TRANSPORTATION

Does your student have reliable transportation arranged for each day of camp?(Required)

Yes

No

PHYSICAL HEALTH HISTORY

Are you able to stand for at least 2 consecutive hours at a time?(Required)

Yes

No

Explain(Required)

Medical Conditions (Allergies, Seizures, Asthma, etc.)

Do you have food allergies?(Required)

Yes

No

Please list:(Required)

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

Camper Attributes for Success

Personal

Maintains good personal hygiene?

Yes

No

Communicates with others and expresses needs clearly

Yes

No

Additional information:

Handles changes in routine and shows flexibility in fluctuating circumstances

Yes

No

Additional information:

SOCIAL & EMOTIONAL

Shows self-regulation and avoids inappropriate outbursts

Yes

No

Additional information:

Respects self and others

Yes

No

Additional information:

Works well in a team and individually

Yes

No

Additional information:

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

Yes

No

Additional information:

COGNITIVE

Functions well in kitchen and classroom learning environments

Yes

No

Additional information:

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

Yes

No

Additional information:

Comprehends written text at a 5th grade level

Yes

No

Additional information:

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

Yes

No

Additional information:

Ability to understand and follow safety protocols

Yes

No

Additional information:

Reasoning sufficient to understand constructive criticism

Yes

No

Additional information:

VOCATIONAL

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

Yes

No

Willing to learn about and use commercial kitchen equipment such as mixers, gas stoves, hoods, convection ovens, and dishwashers.

Yes

No

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