Aphasia Camp Registration Form

Aphasia Camp Sign Up Form

Weekend Camp (June 9th, 10th, 11th)

Fill out this section if you plan to attend the whole weekend camp.


Saturday Day Camp (June 10th)

Please enter this section is you do not plan to attend the whole weekend camp, but only the Saturday camp.


Payment

Please include camp registration full payment with this form unless you are requesting a partial scholarship.

Registration is not tax deductible. 

Make checks payable to and mail this form to:

What type of aphasia is camp designed to address?” 
ACNW was created to serve adults with sudden onset aphasia due to stroke and other brain injuries. Our current programs are not designed for individuals with primary progressive aphasia (PPA).

The Aphasia Network
℅ Lisa Bodry
1209 NE 123rd St.
Kansas City, MO. 64165

If you have additional questions, contact us at: (503) 250-3510 or Email:  lyfrkz@gmail.com


Independence and Assistance for campers:

Campers must be independent or need only a minimum of assistance with:

*Dressing and Grooming

*Transferring into & out of the lower bunk beds

*Mobility

*Toileting – we cannot accommodate incontinence without the use of camper-provided protective garments and the need for a minimum of assistance

*Eating


Medical Support:

*Nurse on duty 24 hours a day. First aid is available. Vital signs can be monitored on a regular basis.

*Campers are responsible for taking personal prescription medications. We do not administer medications.

*Camp is approximately 13 miles from Tillamook Regional Medical Center.

*Most diet preferences/requirements can be accommodated.


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