2023 Culinary Summer Camp Application Step 1 of 2 50% CAMPER INFORMATIONName(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?EDUCATIONWhat 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) TRANSPORTATIONDoes your student have reliable transportation arranged for each day of camp?(Required) Yes No PHYSICAL HEALTH HISTORYAre 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 SuccessPersonalMaintains 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 & EMOTIONALShows 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:COGNITIVEFunctions 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:VOCATIONALHas 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 Δ
