2025 - NW VT FCA - Chittenden All Abilities Power Camp

Participant Enrollment

Attendee Age Range

Minor (17 & under)

Payment Option

Camper ($40.00)

Registration Fee

$1.99

Coupon Code

Sub-Total

$41.99

Camper Name

Camper Address

Camper Age At Time of Camp

Camper Date of Birth

Camper Home Phone Number

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Camper Cell Phone Number

Subscribe to FCA text messages

I would like to receive occasional text messages from FCA about future resources and programs.

Camper Email

Subscribe to the Daily Impact Play email

I would like to receive the Daily Impact Play email, spiritual training for coaches and athletes of all levels.

Camper Gender

Male
Female

Camper School

Grade In Fall

T-Shirt Size

Sport Option 1:

Does the student athlete have prior experience in this sport?

Sport Option 2:

Does the student athlete have prior experience in this sport?

Sport Option 3:

Does the student athlete have prior experience in this sport?

Name of camper's disability:

Please describe how this disability manifests:

Sports/fitness activities in which the camper has already participated or is currently participating

What do you need us to know and understand about this camper?

Does this camper have any triggers?

Are there any activities that can calm this camper if he or she is feeling overwhelmed?

Choose the best that applies. The camper would best learn:

In a typical setting for the camper’s age group with no supports
In a typical setting for the child’s age group with a buddy who is:
- An adult - An older student - A peer
In a separate area with a trained teacher and a small group of other special needs students
A combination of the above. Please describe why you believe this to be your camper's best learning setting selection

Does your camper suffer from seizures?

What other medical concerns should we know about?

Athlete HAS the following Self Help Abilities: (check all that apply)

Athlete HAS the Following Abilities in the area of Following Directions: (check all that apply)

Follows a simple 1 step command
Example: "We are going inside."
Follows an everyday multi step command
Example: "We are all done. We are going inside. It's time for snack."
Follow a multi step process
Example: "First, we will go inside. We sit with our group. Then we have snack.
Follow a complex multi step process
Example: "When we are done with soccer. We will go inside. Sit with our group. Have a snack, play a game. Then it will be time to go home.
I prefer not to answer

If athlete has high medical concerns, toileting needs, or bolting issues and adult would like to remain on the school premises for possible assist.

Chittenden County All Abilities Power Camp

July 28 - 30, 2025

Location Information

Participant Enrollment