ASD Camper Application – West Texas Camps and Retreats

ASD ADVENTURE CAMPER APPLICATION

ASD Adventures is a one-of-a-kind camp experience designed specifically for children with Autism Spectrum Disorder, ages 11-14.

This four-day session gives campers the opportunity to connect with others, explore new activities, and soar beyond expectations — all within a safe, structured environment built with them in mind.

Each session is intentionally limited to 18 campers, ensuring every child receives the individual attention and care they deserve.

Our trained, compassionate staff and volunteers are dedicated to making each camper feel known, valued, and celebrated every single day.

ASD Adventure Camp is provided by West Texas Camps & Retreats. The camp session is at Circle Six Baptist Camp in Lenora, TX.

For more information, download the Camper Information Packet

To reserve a spot for your child, a parent or guardian must first complete a camper application. Applications are reviewed by our team, and families will be notified of their acceptance within 5 business days. Upon approval, registration forms will be sent for complete enrollment.

Because each session is limited to 18 campers, space fills quickly — we encourage families to apply early to secure their child's place at camp.

Camper's First Name

Middle Name

Camper's Last Name

Date of Birth

Age

Last Grade Completed

Parent's/Guardian's Names

Street Address

City

State

Zip code

Primary Phone Number

Does This Phone Recieve Text

Yes No

Secondary Phone Number

Does This Phone Recieve Text

Yes No

Has your child attended overnight camp before?

Yes No

If yes, describe the experience.

What are your child's strenghts and interests?

What are your goals for your child at camp?

How does your child primarily communicate? (Check all that apply)

If other means of communication is used, please describe.

Can unfamiliar people understand your child?

Yes No It is sometimes difficult

How does your child express wants/needs?

Can your child answer basic questions? (name, needs, yes/no, etc.)

Yes NO

How does your child express discomfort, pain, or distress?

Can your child take turns or share?

Yes No Sometimes

How does your child handle losing or not getting their way?

Does your child engage in any of the following? (check all that apply)

Describe what these behaviors look like:

How oftern do these behaviors occur?

Fewer than 2 times per day More than 3 times per day Occasionally

List any sleep related concerns we should know.

Does your child wander at night

Yes No

Does your child need assistance at mealtimes,

Yes No

If yes, explain. Include behaviors like refusing to eat, picky eater, thowing food, etc.

Does your child have other medical diagnosis' that we need to know about?

Can your child dress themselves without assistance?

Yes No

Can your child bathe and use the toilet without assistance?

Yes No

Please explain any concerns you might have about your child attending camp.

By checking the box below, I acknowledge that the information provided in this form will be used to assess whether this camp setting is appropriate and safe for my child. As the parent or guardian, I confirm that all responses are accurate and complete to the best of my knowledge.

I confirm and agree

I understand that West Texas Camps and Retreats staff and volunteers are not licensed medical or clinical professionals. While all volunteers receive camp-specific training, I acknowledge that the care and support provided during the session is not equivalent to professional clinical care. I agree that it is my responsibility to ensure my child's medical and therapeutic needs are communicated fully on this form.

I understand and confirm