The code block below illustrates how one might use # and // as comments in your logic and calculations.

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	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

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AAC Camp in Motion 2026

Please complete the survey to register for AAC Camp in Motion. Please note that all spots are currently full.

**WAITLIST SPOTS REMAINING FOR SUMMER 2026.**

Camp days will be JUNE 8-12, 2026 from 9 AM to 3 PM, Monday through Friday. Preschool Camp (age 2-5) and Camp in Motion will be separate applications. Applications for camp will be considered on a first come first serve basis. Camper applications are limited to individuals who utilize an augmentative communication device of any kind, meaning campers must have a light or high tech communication device in order to participate.

Individuals should require minimal assistance with toileting, dressing and feeding themselves lunch. Individuals that require additional assistance may be required to provide a nurse or caregiver. If you are unsure if your camper is appropriate for participation, please contact us by email at campinmotion@ascension.org.

Individuals who do not wish to utilize camper's insurance to cover camp may pay a cash pay rate of $765 per week. Campers submitting costs through insurance MUST complete a pre-camp evaluation either virtual or in-person at least 2 weeks prior to camp experience in order to ensure insurance authorization is in place. Current speech therapy services will need to be on hold during the week of camp if utilizing insurance. Individuals who do not wish to utilize camper's insurance to cover camp may pay a cash pay rate of $765 per week, due one month prior to start of camp. A doctor's prescription is required for either method of payment.

Camp includes:

Gross motor activities such as swimming, adaptive sports, yoga, dance, scavenger hunts, etc.

Social skills groups & fine motor tabletop activities such as journal time, "cooking class," arts and crafts, board games, etc. Literacy & Language time with interactive musical and video content such as video story times.

Your child will have 1:1 therapy provided during all activities to support their communication and engagement & to target goals you set with an evaluating therapist beforehand. If you have any questions about if this camp is the proper fit for your child, please let us know & we will be happy to discuss further!

Thank you!

Please submit any additional questions to campinmotion@ascension.org

Parent Email Address

Camper information and updates will be communicated via email.

* must provide value

Camper Full Legal Name

Please list full name as will be listed on prescription for medical clearance to camp.

* must provide value

Name for Nametag (If different from above)

Speech Diagnosis

Please list speech diagnosis to be listed on prescription for clearance to camp.

If camper has a diagnosis of cerebral palsy or autism you may list diagnosis as 'Other symbolic dysfunction (R48.8)'

* must provide value

Please list any additional medical diagnoses for your child (ie. Autism, Cerebral Palsy, Down syndrome)

Camper Birthday (MM/DD/YYYY)

* must provide value

M-D-Y

Age at Start of Camp

(Must be 5-20 years old at start of camp)

* must provide value

Camper Shirt Size

* must provide value

Youth Small

Youth Medium

Youth Large

Youth XLarge

Adult Small

Adult Medium

Adult Large

Adult XLarge

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Please note that all participants during this week of camp will receive speech therapy.

Please note that any outside therapy services in this discipline will need to be placed on hold during the week of camp.

Please indicate that you are aware your camper will receive speech therapy.

* must provide value

Yes

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Therapy Goals

Please list any preferred therapy goals for camp. (examples: peer communication, social conversation, AAC navigation)

Please list referring Physician Name
Please include both first and last name of physician.

* must provide value

Referring Physician Phone Name

* must provide value

Referring Physician Fax Number

* must provide value

Gender

* must provide value

Male

Female

Other

Prefer Not to Answer

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Street Number and Street Name

* must provide value

City

* must provide value

Zip Code

* must provide value

Phone Number

* must provide value

Parent Name/Emergency Contact

* must provide value

Relationship to Camper

* must provide value

Mom

Dad

Grandparent

Guardian

Other

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Parent/Emergency Contact Phone

* must provide value

Second Parent/Secondary Emergency Contact Name

* must provide value

Second Parent/Emergency Contact Phone

* must provide value

Camper Medical Information

How does your camper communicate

* must provide value

Verbally-with no deficits

Verbally-with one to two word phrases

Verbally-with some difficulty to understand

Gestures/Signs

Low Tech Communication Device

AAC/High Tech Communication Device/Ipad

Other (if other please list in comments section below)

What speech generating device or AAC program does your child use?

Please list device name, device company, and language system (e.g. TobiiDynavox i110 with TDSnap 5x7, PRC Accent 1000 with Unity 84 sequenced, iPad with ProLoQuo2Go 7x11 grid, PODD book)

* must provide value

How does your child access their device?

* must provide value

Hands

Eye Gaze

Head Point

Switch Access/Buttons

Other

Does your child have any of the following equipment?

* must provide value

None

Hand Orthotics/Braces

Leg Orthotics/Braces

Walker

Gait Trainer

Wheelchair-Manual

Wheelchair-Power

Other Equipment (please list in comments below)

What equipment will be primarily used for mobility at camp?

* must provide value

None

Hand Orthotics/Braces

Leg Orthotics/Braces

Walker

Gait Trainer

Wheelchair-Manual

Wheelchair-Power

Other Equipment (please list in comments below)

Indicate the level of help your child needs to dress for swimming.

* must provide value

Full Help Needed (Dependent)

Some Help Needed (Please list needs below)

No Help Needed (Independent)

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Indicate the level of help your child needs for transfers. (moving from chair/wheelchair to floor)

* must provide value

Full Help Needed (Dependent)

Some Help Needed (Please list needs below)

No Help Needed (Independent)

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Indicate the level of help your child needs for toileting.

* must provide value

Full Help Needed (Dependent)

Some Help Needed (Please list needs below)

No Help Needed (Independent)

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Comments from Questions Above

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Does your child have any of the following deficits?

* must provide value

vision-wears glasses

vision-cortical vision impairment

feeding-requires assistance with opening containers/packages

feeding-requires assistance for eating

feeding-requires g-tube feed (RN or caregiver will be required to provide at camp)

hearing-wears hearing aide/cochlear implant

hearing-uses ASL interpreter

other (please list in comments below)

Please list any allergies your child might have.

* must provide value

Please list any additional needs that your child has. Please note any items that may limit your camper or other campers from fully participating in the camp experience.

* must provide value

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Please list any medications your child is taking and indicate which ones will need to be taken during the camp day. If no medications taken at camp, please write none.

* must provide value

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If you wish to add any additional information about your camper, please indicate in this section below. Please any comments from questions above if needed.

* must provide value

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Attendance Policy
I understand the importance of consistent daily attendance at Camp in Motion as it pertains to the physical and social aspects for my camper. I will make every attempt to attend daily as I understand other campers will be on a waiting list and may have attended this week. I will communicate needs to arrive late or leave early to camp staff in advance to ensure that all camper's have an ideal camp experience. I understand that previous attendance issues including 'no-shows' and late notice cancellation (less than 2 weeks notice) may result in placement on the bottom of the waitlist for future programming.

* must provide value

Yes

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Behavior Policy

I understand that any behaviors resulting in harm to self, peers, volunteers, and/or staff will result in direct communication from the Camp in Motion staff. A second incidence of behavior may result in dismissal from the program. I will communicate any appropriate tools or strategies to help my camper comply with the behavior policy.

* must provide value

Yes

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Insurance Policy

I understand that if I wish to bill insurance to cover the cost of Camp in Motion, that I must place my current therapy on hold for the week(s) attending camp, starting before the first day of camp, to improve re-reimbursement for camp. I understand that I am responsible for my out-of-pocket expenses, deductible, and co-pay that have been un-met prior to camp.

* must provide value

Yes

I do not wish to bill insurance for camp

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Primary Insurance

* must provide value

Cashpay (please check only if you do not wish to bill insurance, if you do not see your insurance please click other)

Aetna

Blue Cross Ascension SmartHealth

BCBS Texas

BCBS Out-of-State

BCBS STAR

Community First

CHIP

Humana

Superior Star

Traditional Medicaid

Tricare

United HealthCare

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Secondary Insurance

* must provide value

No Secondary Insurance

Cashpay (please check only if you do not wish to bill insurance, if you do not see your insurance please click other)

Aetna

Blue Cross Ascension SmartHealth

BCBS Texas

BCBS Out-of-State

BCBS STAR

Community First

CHIP

Humana

Superior Star

Traditional Medicaid

Tricare

United HealthCare

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Policy Holder's Name (If not billing insurance, please put N/A in the following section)

* must provide value

Insurance Group Number (If not billing insurance, please put N/A in the following section)

* must provide value

Insurance Policy Number (If not billing insurance, please put N/A in the following section)

* must provide value

Secondary Insurance Information

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Upload FRONT of Insurance Card(s) (Picture of both cards together if you have a secondary insurance)

* must provide value

Upload file

Upload BACK of Insurance Card(s) (Picture of both cards together if you have a secondary insurance)

Upload file

If you are new to Camp In Motion, how did you hear about us?

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I certify that I have read the camp policies and that the information above is correct.

* must provide value

Add signature

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