Camp
Recognition Award
Please
print out this form, complete it and return with supporting documentation
to:
CCPD Executive Director
301 E. Pine St. Suite 150
Orlando, FL 32801
Phone: 407-210-3917
Fax: 407-835-3601
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Your
name_______________________________________________
Your
address ____________________________________________
City/State/Zip___________________________________________
Your
phone (_____) ______________________________________
Email
address ___________________________________________
Name
of camp___________________________________________
Contact
person at camp___________________________________
Camp
Address: _________________________________________
________________________________________________________
Phone
(_____) ___________________________________________
Camp's
URL & Primary Email: ________________________________
_______________________________________________________
Years
the camp has been serving people with disabilities:______
| Camp
serves (check all that apply): |
|
_____Children
with disabilities
_____Adults
with disabilities
|
_____Family
as a whole
_____Ambulatory
only
|
|
Disabilities
that camp is able to serve:
|
| _____Physical
Disability |
_____Deaf/Hard
of Hearing |
| _____Cognitive
Disability |
_____Mental
Illness |
| _____Blind/Low-Vision |
_____Chronic Illness |
| _____Environmental
Illnes |
_____Brain Trauma |
| _____ |
Other:___________________ |
Are
people with disabilities integrated into the life of the camp?
Yes _____ No ______
How? Please describe:
Number
of people with disabilities served annually: __________
Is the camp a member of CCI? _____________
| How
is Christian faith incorporated into the camping program? |
| ____
Bible study |
_____
Prayer |
| Other:
|
| Activities
open to all campers: |
| _____swimming
|
_____fishing |
| _____horseback
riding |
_____hiking |
| _____handicrafts |
_____outdoor
cooking |
| _____competitive
sports |
_____hayrides
|
| _____
Worship services |
_____softball |
| _____boating |
_____canoeing |
| _____adventure
trips |
_____nature
study |
| _____drama
|
|
| Other:_____________________________________ |
Are
all buildings, bathrooms, meeting areas and hiking trails handicapped
accessible? __________
(If answer is no, explain on separate sheet of paper.)
Length
of camping season in which people with disabilities are involved:
___________________________
| Persons
with disabilities are: |
| ______
served only during special weeks
______mainstreamed
throughout the entire camping season.
|
List
any other special programs offered, such as parent retreats,
counseling, etc.:
Do
any staff have disabilities? _____Yes _____ No
Identify their roles:
On
an additional sheet(s) of paper, please describe your reasons
for nominating this camp.
Include
any materials and brochures that are relevant.
What
is the cost per person? $ ____________________
Are there any scholarships?
________Yes ________ No
What
is the camp's geographic area? __________________________________________________
