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Camp Paivika - Reservation Questionnaire for Summer Camp 2026

Dear Campers, Family Members and Care Providers:

Thank you for your interest in reserving a spot at Camp Paivika for this summer 2026!

The first step in registering for summer 2026 is to get to know the care and supervision needs of the camper. We will work together with you to identify the correct session placement.

Sessions 1 through 6 are for campers who are interested in becoming part of our camp community. They will enjoy their time at camp with a 2:5 staffing ratio and a 1:25 ratio for nursing care.

Session 7 is an independent adult session for campers 18 and older who are interested in attending Camp Paivika with no support staff in the cabins. This session is designed to reinforce the independence of campers who may live alone, or who are working towards total independence. The campers who attend this session will have to meet their own care needs (personal care and/or nursing care, and supervision). Camp Paivika will only provide daily programming and meals.

Friends and Family sessions 1 through 3 are for campers and families who are new to the idea of camp. This session is also designed for campers who cannot have their needs safely met in a 1:25 nursing ratio or a 2:5 camper to staff ratio. We require the camper be accompanied by a companion who understands they are responsible for the care and supervision of the camper while at camp. Family camp is open to more than just the camper and their companion, we encourage members of the family and or friends to attend as well to build our camp community. Family camp is a great way for families to get to know and build trust for the Camp Paivika camp community and facility. Camp Paivika is a great place to have a family vacation where you get to meet others with like experiences.

Please complete ALL required fields (*) on this questionnaire to ensure your submission is received.

We will review and invite campers to register in the order the reservation questionnaires are COMPLETED and received so don't delay! It is important you click "Submit" at the end (this will ensure the questioner is received). This will add a date and time stamp to your survey. We use the time stamped response to ensure summer camp spots are filled in a fair and equitable way.

What will happen after the survey is submitted?

  • If we do not have any questions, we will send you a registration link via email to register in ACTIVE. You will have two (2) weeks after you are notified to complete the on-line registration and pay the required $150 deposit. If not completed in the two (2) week time frame your registration will not be guaranteed.
  • If you are a first-time camper, we will contact you via email to set up an intake. Please respond in a timely manner, as your registration link cannot be sent until we speak.
  • If the camper does not make it into a session we will place them on the waitlist. Camp staff will notify you via email on your waitlist position. Campers who are higher on the waitlist will be sent a link to register through ACTIVE as a waitlist status registrant. Camper will be required to fill out needed paperwork and complete the medical exam to ensure they remain on the top of the waitlist. If there is a last-minute cancelation the waitlist registrants will be invited to attend the session if all documentation and a medical exam is completed. If not completed next waitlist registrant will be invited.

    We strive to provide the best and safest program we can, and this process allows us to ensure the right fit for you camper's needs.

    We look forward to speaking with you soon!
    The Camp Paivika Staff
    1.Camper Name:(Required.)
    2.Camper's Disability(Required.)
    3.Gender(Required.)
    4.Has camper attended Camp Paivika previously?(Required.)
    5.Does camper require 1-to-1 care or supervision in other programs or in school?(Required.)
    6.How old will camper be this summer?(Required.)
    7.Mobility(Required.)
    Walks unaided
    Camper needs assistance
    Camper uses braces/canes/walker
    Camper uses wheelchair
    Walking
    8.If camper needs assistance with mobility, please add what type of assistance is needed.
    9.Wheelchair Use - answer only if camper use a wheelchair.
    Yes
    No
    Will use an electric wheelchair while at camp
    Will use a manual wheelchair while at camp all of the time
    Will use a wheelchair as needed, such as for long distances or fatigue
    10.Transfers - answer only if camper uses a wheelchair.
    Yes
    No
    Camper self-transfers
    Camper can bear weight during transfers
    Camper uses a Hoyer lift for transfers
    11.If camper needs support with lifting and transferring or use of a mechanical transfer, please add how much your camper weighs.
    12.If camper needs assistance transferring will transfer equipment be sent with camper? Camp Paivika has Hoyer lifts available but if campers and families feel more comfortable using their own equipment, families will have to show camp staff how to operate.
    13.Medications and Supplements(Required.)
    Does not take any medication and/or supplements per day.
    Takes 1 to 5 medications and/or supplements per day.
    Takes 6 to 10 medications and/or supplements per day.
    Takes 11 to 15 medications and/or supplements per day.
    Takes 16 to 20 medication and/or supplements per day.
    Takes more than 21 medications and/or supplements per day.
    Number of medications AND or supplements taken per day
    14.Types of medications needed at camp per day(Required.)
    15.Nursing Care(Required.)
    No
    Yes - 5 to 15 minutes
    Yes - 16 to 29 minutes
    Yes - 30 minutes +
    Catheter
    Bowel Care
    G-Tube
    Trach Care
    Wound Care
    Breathing Treatment
    Diabetic Care
    16.Personal Hygiene care needs(Required.)
    Independent
    Independent with prompting
    Requires some assistance
    Requires total assistance
    Hygiene (brushing teeth, washing face, combing hair)
    Showering
    Dressing
    17.Toileting(Required.)
    Independent
    Independent with prompting
    Requires some assistance
    Requires total assistance
    Using toilet
    Catheter
    Wears incontinence briefs
    18.Nighttime needs(Required.)
    Sleeps through the night
    Gets up during the night and will require assistance
    Needs to be turned during the night
    Camper overnight support
    19.If camper has nighttime needs, please explain what a typical night with support would look like.
    20.Meal time support(Required.)
    Independent
    Requires some assistance (ie: setting up food/drink, cutting food)
    Requires total assistance
    Eating
    Drinking
    21.Special Dietary needs(Required.)
    Yes
    No
    Requires a special diet
    Requires food to be pureed or finely chopped
    Has food allergies
    22.Other things to know about my camper to help camp staff support them and meet their needs(Required.)
    Never
    Occasionally
    Often
    Daily 
    Has challenging behaviors
    Has temper outbursts
    Has disruptive or assaultive behaviors
    Wanders away from groups
    Unable to sleep through the night
    Challenging mealtime behaviors like refuses to eat
    23.Please pick your top three choices(Required.)
    First Choice
    Second Choice
    Third Choice
    Session 1: Adults - 18 or older - June 21 - 26 (Sun - Fri)
    Session 2: Adults - 18 or older - June 29 - July 4 (Mon - Sat)
    Session 3: Adults - 18 or older - July 7 - 12 (Tue - Sun)
    Session 4: Adults - 18 or older - July 15 - 20 (Wed - Mon)
    Session 5: Children - 9 to 17 years old - July 23 - 28 (Thrus - Tue)
    Session 6: Adults - 18 or older - July 31 - Aug 5 (Fri - Wed)
    Friends & Family Session 1 - All Ages- Aug 8- Aug 11 (Sat - Tue)
    Friends & Family Session 2 - All Ages- Aug 14- Aug 17 (Fri-Mon)
    Friends & Family Session 3 - All Ages- Aug 20 - 23 (Thurs - Sun)
    Session 7: Independent Adults (NO CABIN STAFF) - 18 or older - Aug 26 - Aug 30 (Wed - Sun)
    24.Name of friends they want to be in the same session
    25.Name of contact and relationship to camper for an intake with or for the campers.
    26.Email address:(Required.)
    27.Cell phone number:(Required.)
    28.Can we text you at the cell phone number listed above?(Required.)
    29.What is the best time of day to reach you?(Required.)
    30.Once notified that you/your camper is registered, you will have 2 weeks to complete the online registration forms (not including the medical form) and pay a minimum of the $150 deposit.(Required.)
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