2025 Adaptive Bible Camp

Registration Contact Information

Thank you for registering your child. We are pleased to offer this free experience as part of our expanding Autism Ministry. Dates are August 4th -August 7th, 10 a.m. to noon. We are happy to partner with Good Samaritan UMC this summer. This camp is for children 3.5 years and up. Please fill out this form completely and a seperate form for every child.

Name of Individual Completing this form

Email to be contacted at

This address will receive a confirmation email

Additional Email

Phone

Address

Child Basic Information

Name

Date of Birth

Grade Completed Spring 2025

Special Needs/Allergies?

Emergency Contact Name

Emergency Contact Phone

Relationship of Emergency Contact to Child

If someone other than parent/guardian will pick up your child, please provide name and phone number

Tell us about your child

Why are you choosing an Adpative Bible Camp experience?

Please describe your child's strength and interests. What motivates them? What is fun for them?

How does your child communicate their needs?

Please describe any challenging behaviors your child demonstrates that may inpact their ability to participate in Adaptive Bible Camp

What triggers these challenging behaviors? What helps?

How does your child handle transitions?

Does your child have any repetitive behaviors?

What sensory inputs bother your child and in what way? Example: Touch, movement, sounds, proximity to others, lights, textures, or smells.

What sensory inputs does your child seek out? Example: Touch, movement, sounds, proximity to others, lights, textures, or smells.

Is your child toilet trained? Are they able to tell others when they need to use the bathroom? What support do they need in the bathroom?

Does your child need 1 to 1 support?

Please describe your child's attention span and your child's ability to sit in a group

What are your goals for this Adaptive Bible Camp Experience?

What do you love most about your child?

Is there anything else you would like us to know?

Photo Release

Do you give permission for your child's photo to be used without compensation on the Eden Prairie UMC website, Tumbleweed newsletter, and social media (including but not limited to Facebook, Twitter, Instagram and YouTube) for viewing by the public through internet access. Personal identifiers (first and last names) will not be used. This permission also extends to sharing images, audio and words with the Minnesota Annual Conference of the United Methodist Church for publicity and promotional purposes, including articles shared through the MAC website.

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2025 Adaptive Bible Camp

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