AHSLC Youth Camp Experience

Phone *

Youth Camp Applicattion (9-18)

What are your hobbies and interests? *

City, State Zip *

Birth Date *

Name: *

Questionnaire - for PARENT/GUARDIAN

Click here for an article about the Summer School for Visually Impaired Youth

Please read carefully. Indicate agreement by typing the name of the parent/guardian and the date in the form above.

I understand that after reasonable precautions are taken, there are hazards connected with the camp experience, and I release the Wyoming Lions Summer School for the Visually Impaired Youth, its directors, agents and employees from liability for accidents which may occur in connection with camp activities. I certify that the applicant child is physically able to attend a camp at 8,000 feet elevation and have no medical issues that have not been discussed thoroughly with the camp nurse and staff. I grant permission for necessary emergency treatment by a medical doctor or hospital in the event a medical emergency arises and prompt treatment is required for me. I understand that the adult camp will contact my emergency number immediately. I grant permission to use photographs, video and sound reproductions in publicity authorized by the Summer School, which may contain pictures of the child during normal camp activities.

Emergency Contact Name *

Physician's Name *

Fill in all boxes and click submit

Allen H. Stewart

Lions Camp

Parent/Guardian Name *

Physician's Phone *

List your choice of electives in order of preference. Crafts, Digital Photography, Lapidary, Music, Pottery, Outdoor Adventure, Woodworking/Shop .(See complete class descriptions below.) *

Additional Comments

Please check one: I authorize my eye report to be released to adult camp staff. *

Yes

What would you like to achieve from your camp experience? *

Address *

Camp Questionnaire - for CAMPER

Relationship *

By typing my name, I acknowledge I have read, understand and agree to the conditions stated below on this web page. *

What are the greatest challenges you face as a result of your vision loss? *

What skills or experiences would you like your child to gain at camp? *

Additional Comments

What are the greatest challenges your child faces as a result of vision loss? *

Relationship *

Date signed *

All Campers must participate in these classes:

Orientation and Mobility: Becoming a safe and efficient traveler is one of life’s greatest skills as a visually impaired individual. O & M helps develop or advance skill and confidence in independent travel. Lessons are individualized to meet the needs of each student, and may include residential or business travel in and around Casper. Use of the white can and low vision aids are taught, but this class is not limited to white cane users.

Activities of Daily Living/Cooking: This class introduces students to household and daily living skills. Cooking techniques, using kitchen appliances and utensils safely, and basic meal preparation and clean-up are practiced. Students in this class will also take part in the preparation and serving of dinner on Parent’s Night.

Assistive Technology/Computer: Explore new technology, learn to keyboard or work process, or advance your skills on the Internet or with social networking. This class is for any level of computer user and is student-need based. It includes the use of games, Braille, screen readers or low vision technology to increase computer competency.

Elective Course Descriptions

Crafts: Crafts of various types will be explored in this general crafts class. Each student will have a project to take home at the end of the week, as well as a great feeling of accomplishment. Perhaps, a new leisure hobby will be discovered.

Digital Photography: Students will be loaned a digital camera for this class and encouraged to explore different aspect of photography. The use of low vision devices will enable students with limited vision to view their work and each student will be given their photos at the end of the week.

Lapidary: One of the favorite classes at camp! Lapidary is the art of making beautiful jewelry or projects from rocks and precious stones. Campers will complete each step of this process independently, from choosing the stone to mounting the finished product in a setting. Each student will have project to take home at the end of the week

Music: If you love music, this class is for you!! Discover your hidden talent or bring your favorite instrument to further instruction and have fun. You don’t have to be a musician for this class, just enjoy and appreciate any type of music! Pottery: Try your hand at a pinch pot, a special creation, or throw a pot on the wheel. Pottery class gives exposure and experience to the craft of making things with clay. A kiln in the craft cabin allows you to glaze and fire your project before taking it home.

Outdoor Adventure: Individual instruction is given to students with special interest. Do you want to ride a tandem bike, play a game with teammates, learn to swing a bat or hike? Do you want to learn how to build a fire, or hike on the Braille Trail? Expand your horizons!

Woodworking/Shop: This class teaches safe use of basic shop and woodworking tools. It incorporates measuring, cutting, painting and other woodworking skills as students construct a special project to take home.

Any files may be submitted here or mailed.

Phone (if different)

Phone

ELIGIBILITY GUIDELINES

1. Participants must be visually impaired, 20/70 or 20 degrees of loss, best correction as defined by state guidelines, and provide a medical report from his/her eye doctor within the last year with application packet.

2. Participants must be 9 to 18 years of age.

3. Participants must be independent in their personal care needs (i.e. toileting, eating, dressing, showering, etc.)

4. Participants are responsible for providing their own transportation to and from camp.

5. All applications must be received by May 15, 2022.

6. Medical forms will be reviewed by staff prior to acceptance to Camp.

7. Participants are responsible for providing any needed prescription and/or non- prescription medications. No medications are provided by the Camp.

TRANSPORTATION

All participants are asked to furnish their own transportation to and from the camp.

• Participant needs to arrive between 2:00 pm and 4:00 pm on Sunday July 10th

• Participant will depart on Friday, July 15th after the “BBQ and the Talent Show.”

Participants may be released at approximately 7:30pm after all activities have concluded.
All projects need to be picked up and individual dorm spaces must be cleaned prior to departing camp.

• Transportation to-and-from camp might be available for students in some cases.