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Parent Questionnaire


As you complete the parent questionnaire, please provide any and all information you feel will be helpful for us to know about your child. Whether your child is new to Iroquois Springs, or a returning camper, tell us how their year has been and what they are most excited (and apprehensive) about. This information is communicated to your child's counselors during our staff orientation. It allows them to be best prepared to help support and nurture your child emotionally, socially and programmatically. The form below contains a section where you can make up to three (3) bunk requests. Please note that bunking requests should be reciprocal, so we will need a matching request from a bunkmate. We will try to honor all requests.

Your e-mail address

Camper Information
Please upload a photo of your child (.jpg, .gif or .png, 1MB or less):

Camper's first name
Camper's last name
Date of Birth:
Name of town camper lives in
Grade entering in Fall 2010
Session attending

Personality
Please note: The philosophy of camp emphasizes that each child is unique. Therefore, it is important for us to learn as much about each camper as possible.

Has your child been to camp before?	YesNo
Name of camp
Years at former camp
Was your child homesick?	YesNo

Is your child eager to come to camp? Please explain.


List the activities in which your child excels.


List the activities in which you would like your child to participate.


What does your child do with his or her spare time?


In what way would you like camp to develop your child's...

...habits:


...skills:


...social activities:


Does your child have any fears, i.e. the dark, heights, etc? If so, explain.


Does your child make friends quickly?
Is your child shy?
Is your child timid?

Is your child happier alone, or with other children?


List, in order of preference, up to three campers your son or daughter would most enjoy in their cabin.


What would you like your child to get out of their experience at camp this summer?


Physical and Emotional Info

Has your child been in psychological counselling in the past 2 years? If so, please explain.


Does your child take any medications at camp? If yes, which medications?


Does your child have any past illnesses of which we should be aware?


Has your child been hospitalized in the past year? If so, please explain.


Please select 'yes' if your child is prone to any of the following, and explain, if necessary, below.
Tendency to colds	YesNo
Fainting spells	YesNo
Constipated frequently	YesNo
Tendency to gain weight	YesNo
Bed wetting	YesNo

If you checked 'yes' to any of the above, please explain.


Does your child wake up during the night?	YesNo
Does your child walk in their sleep?	YesNo
Does your child talk in their sleep?	YesNo
How is your child's appetite?

Any foods not allowed for medical reasons?


Is your child a vegetarian?	YesNo

Does your child have any other allergies you have not yet listed?


Family and Home Life

Name and age of any siblings


Mother's occupation
Father's occupation
Marital status
Who does your child live with?

Any other information that we should know about your child?