Summer Camp & Shore Program

The Camp/Shore summer program provides an age-appropriate socialization experience for anyone over the age of 18. The first four weeks of the summer are designated as ‘Camp’ weeks, which cater to those individuals who would prefer a structured, summer camp type of atmosphere. These weeks are based almost entirely at our home in Rio Grande, NJ, offering activities such as arts & crafts, music, sports, swimming, etc.

These activities follow a theme that changes each week to make it fun and interactive. The remaining 7 weeks of the summer are designated as ‘Shore’ weeks, providing a vacation-like atmosphere, with outings to Atlantic City, the beach, Wildwood boardwalks, nature centers, and many more!

Helping Hands, Inc. is offering our summer residential/vacation camp for individuals with intellectual disabilities. ALL WEEKS WILL BE BASED at the property in Rio Grande, New Jersey. Cost is $1250.00/week.

Summer Camp for Disabled Adults | Helping Hands Inc | Bechtelsville PA

Shore Weeks

July 10 – July 15, 2022

July 17 – July 22, 2022

July 24 – July 29, 2022

Shore Weeks

July 31 – Aug 5, 2022

Aug 7 – Aug 12, 2022 (Minimal Supervision)

Aug 14 – Aug 19, 2022 (Minimal Supervision)

Aug 21 – Aug 26, 2022 (Minimal Supervision)

Covid-19 Vaccinations are not required but are PREFERRED.

We will be returning to full capacity, which means we will have 10-12 open spots for each Camp & Shore week. Each participant may choose one week of each program, if desired.

Please contact Jaimee Scott for tentative registrations or if you have any questions. The most efficient method is via email. Slots are completely reserved after confirmation is received from Jaimee Scott, Camp Director.

Payment Information

For participants who are NOT utilizing waiver funding, a deposit of $50.00 for each week is required by Helping Hands.
Waiver-funded participants- Summer Program cost is $250 per day. Please communicate this information to your Supports Coordinator. It is your responsibility to inform HH if you will be utilizing waiver funding for our summer programs.
Waiver funded participants are REQUIRED to have authorized service units available prior to attendance. Private Pay participants must submit their FULL PAYMENT at least 4 weeks prior to their scheduled week.

Each week is open to participants 18+. All weeks are $1250.00.

All registrations are at the discretion of Helping Hands, Inc. To avoid any confusion, Jaimee is the ONLY person who will make reservations.

Register Now

Upon acceptance, participants will be sent an application packet that must be returned to the office no later than two weeks prior to your registered week. You will then receive an acceptance letter and a packing list.
**For private pay participants, FULL PAYMENT is required four weeks prior to your registered week.
We will be accepting registration requests for returning participants through April 15^th, 2022 and registration requests for new participants will be accepted starting April 18^th, 2022. Upon confirmation of the participants’ request, an application packet will be sent out. Once the application packet has been received, an acceptance letter will be sent out along with a packing list.

Step 1 of 13

Dear Participants, Families, and Caregivers:

As you may have already suspected, the 2021 summer season will look very different from past summers. This year we will be taking a limited number of participants each week. These spots are first come, first serve. We will still expect the same application and requirements as usual, so below you will find specific instructions on completing this packet. We’re glad to be able to get back to some type of normalcy and spend Helping Hands’ Fun ‘n Sun 2021 with you!

** Please make sure to attach a copy of your Covid-19 vaccination card. Participants will not be able to attend without this proof of vaccination. **

Application Procedure:

1. The mandatory registration deposit of $50.00 for each week is to be submitted to Helping Hands, Inc to confirm your reservation, unless this week will be waiver funded. This deposit will be applied toward the total cost of the program. This deposit is non-refundable. The remainder of the balance is due four weeks prior to the scheduled week, unless other arrangements have been made with our office. There is no $50.00 deposit required if utilizing waiver funding. If you plan to utilize waiver money, contact your supports coordinator ASAP for approval in the ISP. Note: If your summer program is being paid by the county/outside agency, and must be paid in full by that resource, you must still pay your $50.00 deposit and it will be reimbursed to you at the end of the summer season. With any questions regarding the above, feel free to contact Connie Panepinto at cpanepinto@helpinghandsinc.com.

2. Please complete the enclosed forms fully and with accurate information. Please utilize additional paper for any forms if necessary. Failure to supply information will delay the application process. Please keep in mind that the summer programs are completely separate from any other agency programs, therefore, with the exception of physical forms, information from other programs is not transferable. The packets are extensive yet provide necessary information for the staff who will be working the programs.

3. Physical Form- all participants MUST have a completed physical examination form signed by a licensed physician within one year prior to their arrival. This form may be brought with the participant upon arrival to their scheduled session, if need be. However, failure to supply us with this information may result in refusal of admittance to the program. Note: Physical forms from other programs may be accepted, but please contact Jaimee Scott for further information.

4. All application forms will be processed in the order in which they are received. Complete and return your application as quickly as possible. Within two weeks of our receipt of your application, you will receive notice regarding acceptance and scheduled sessions, along with a suggested packing list for the week and directions to the Helping Hands Office. It is NOT included in this packet.

5. NOTE: As part of your registration, we are asking for a photo of the participant (scanned photos are acceptable) and photocopies of insurance cards and identification card.

6. If you have any additional questions and need more information regarding specialized issues and/or circumstances, please contact our office at 610-754-6491 or email me at jscott@helpinghandsinc.com.

Participant's Name(Required)

First Last

Camp Weeks:
June 5 - June 10, 2022
June 12 - June 17, 2022
June 19 - June 24, 2022
June 26 - July 1, 2022

Shore Weeks
July 10 - July 15, 2022
July 17 - July 22, 2022
July 24 - July 29, 2022
July 31 - Aug 5, 2022
Aug 7 - Aug 12, 2022 (Minimal Supervision)
Aug 14 - Aug 19, 2022 (Minimal Supervision)
Aug 21 - Aug 26, 2022 (Minimal Supervision)

Summer Camp Week Desired(Required)

Family/Caregiver Email Address(Required)

FUNDING: What will the funding source be for the summer program?(Required)

You may select more than one.

Waiver Funding

Self/Care Giver Funding

Other Funding Resources (specify)

Supports Coordinator: Agency, Name, and Phone Number(Required)

Supports Coordinator Email(Required)

Has your supports coordinator been notified of the usage of waiver funding?(Required)

How much $ for Self/Care Giver Funding?(Required)

How much $ for Other Funding Resources?(Required)

Contact Information phone number & email(Required)

TOTAL BALANCE: $1250.00 per week

How did you hear about the Helping Hands Summer Program?(Required)

Will the participant be attending any other programs this summer?(Required)

If yes, where?(Required)

Total Payment, unless other arrangements have been made, is due 4 weeks before the start of the session checked. If you have any questions regarding payment, please contact Connie Panepinto at cpanepinto@helpinghandsinc.com. Please make checks payable to: Helping Hands, Inc.

Also, please be sure to note the name of the participant on the check or attach a note.

Participant's Name(Required)

First Last

Age(Required)

Week Scheduled(Required)

Address(Required)

Street Address City State ZIP Code

County(Required)

Date of Birth(Required)

Nationality(Required)

Phone Number(Required)

Parent/Guardian Name(Required)

First Last

Phone Number(Required)

Email Contact(Required)

Emergency Contact Information (While Participating in Summer Programs):

Contact Person #1(Required)

First Last

Cell Number(Required)

Work Phone Number(Required)

Home Phone Number(Required)

How is this contact related to the participant?(Required)

Contact Person #2(Required)

First Last

Cell Number(Required)

Work Phone Number(Required)

Home Phone Number(Required)

How is this contact related to the participant?(Required)

If the participant lives in a residential program/lifesharing:

Provider Agency(Required)

Contact Person(Required)

First Last

Email Contact(Required)

Contact's Number(Required)

Supports Coordinator & Agency

Supports Coordinator Email(Required)

Phone Number(Required)

Is participant utilizing waiver funding?(Required)

Other Funding Resources(Required)

Participant's Day Program(Required)

Location(Required)

Street Address City State ZIP Code

MEDICAL SUMMARY:

Does the participant have a Lifetime Medical History? If yes, Please attach/photocopy.

File Upload

Accepted file types: jpg, pdf, png, Max. file size: 2 GB.

Medical Insurance Company Name(Required)

Policy Number(Required)

ACCESS or Medical Assistance Number(Required)

Social Security Number(Required)

Secondary Insurance(Required)

Primary Physician(Required)

Phone Number(Required)

Primary Diagnosis(Required)

Secondary Diagnosis(Required)

Seizure Activity(Required)

Type(Required)

Brief Description(Required)

Symptoms of Onset(Required)

Aftercare Instructions/Protocols: (when to call 911, rest, etc.)(Required)

Frequency(Required)

Date of Last Seizure(Required)

Any Known Allergies: (bees/animals/flowers/seafood/ or any other foods items, etc...)(Required)

Activity Limitations: (hiking, swimming, lifting, amusement ridess, flashing lights, etc...)(Required)

ISP/BEHAVIORAL SUMMARY:

Will there be suggested goals/outcomes carried out while at the summer programs? If yes, please elaborate.(Required)

Is the participant following a behavior management plan?(Required)

If yes, please attach plan and attach instructions if necessary.

File Upload

Accepted file types: jpg, pdf, png, Max. file size: 2 GB.

What plans will be utilized/followed during summer sessions?(Required)

Any behavioral information/tips(Required)

Does the participant have any current/history of the following: If yes, please explain in detail and utilize additional paperwork if necessary.

Self-Injurious Behavior(Required)

Abuse of others (physically/verbally)(Required)

Sleeping Problems/concerns in unfamiliar surroundings(Required)

Has the participant slept away from home/provider in the last year?(Required)

Elopement(Required)

Loud Noise Behavior(Required)

Other Pertinent Information/Concerns (refusals/history)(Required)

Showertime/Dressing Needs: please check all that apply(Required)

Participant usually takes showers

Participant usually takes baths

Fearful of water

Participant usually showers in the AM

Participant usually showers in the PM

Any routines that might be helpful?

Does the participant wash his/her own hair?(Required)

Is the participant able to regulate his/her own water temperature?(Required)

Does the participant need assistance with shaving? If yes, provide tips for staff (before/after shower, razor/electric?)(Required)

Dental Information/Teeth Brushing Routine:

Does the participant wear dentures? (If so, are they full dentures or partials?)(Required)

Does the participant brush his/her own teeth at home?(Required)

Yes

Sometimes

How much/what kind of assistance is needed, if necessary?(Required)

Adaptive/Medical Equipment to be utilized: Please check/describe all that apply

Leg Braces (special instructions)(Required)

Arm/Hand Braces - Please attach instructions(Required)

Physical Therapies while attending: (details: frequency/special instructions)(Required)

Communication Devices: (details: frequency/how to recharge device/special instructions)(Required)

Feeding adapters (describe)(Required)

C-Pap Machine(Required)

Side Bed Rails (we can provide)(Required)

Wheelchair/Electric Wheelchair(Required)

Walker or Walker with a seat(Required)

Bed Wedges (we can provide) - provide instructions(Required)

Does the participant have a rotation schedule during the overnight hours? Explain.(Required)

Does the participant have a schedule for repositioning during the day/overhigh hours? Explain.(Required)

Other

Any other pertinent information relative to the participant that might be helpful: (further details on anything listed prior, etc.)

Permissions

Emergency Treatment Consent(Required)

I grant permission for participant to receive medical attention/treatment by a doctor/hospital and/or any First Aid/CPR/Water Safety trained staff member if it is so required while he or she is attending any agency programs.

I agree to the Emergency Treatment Consent.

Medication Administration(Required)

I grant permission for participant to be administered prescription medication by program staff when necessary. For anyone who takes medication, please be sure to have it in the PRESCRIPTION CONTAINER(S)

I agree to the Medication Administration Consent.

Picture Consent(Required)

I give my consent for the taking and using of pictures of participant via advertising, social media, fundraising, etc. for the purpose of furthering services for persons served by Helping Hands, Inc.

I agree to the Picture Consent.

Short Trip Consent(Required)

I grant my permission for participant to participate in short trips as part of the agency’s programs.

I agree to the Short Trip Consent.

Summer Camp/Shore Vacation Programs Liability Waiver Form

As the parent/caregiver/legal guardian of the above named individual. I hereby grant permission for the individual to participate in the Helping Hands, Inc. Summer Camp/Vacation Program. I assume full responsibility for any/all injuries or damages which may occur to the individual in, on, or about the shore camp/vacation site, or arising out of its on site or off site activities. I do hereby release and discharge Helping Hands, Inc. and all persons associated with it from any and all claims, demands, rights of action, or causes of action, present or future, whether same be known, anticipated, or unanticipated, resulting from or arising out of the individual participation in the programs and activities of the foresaid Summer Camp/Vacation Program. I further grant permission to provide emergency first-aid and/or medical care to the individual in case of injury or illness as deemed appropriate by Helping Hands, Inc. or a physician. I assume full responsibility for all medical expenses incurred for the treatment.

Participant Name

First Last

Address

Street Address Address Line 2 City State ZIP Code

Father/Mother/Guardian/Caregiver/Provider

Home Phone

Work Phone

Cell Phone

Emergency Contact Name

Emergency Contact Phone Number

Parent/Guardian/Caregiver/Provider Signature

Date

PAY ONLINE AS MUCH OR AS LITTLE AS YOU WANT TOWARDS CAMP!
*All CC payments must be done through PayPal online, not over the phone. Thank you!

Special Vacations Program

As an extension of our S/R and Camp Programs,’ Helping Hands, Inc. coordinates special vacations at the request of our clients. Past trips included cruises to the Caribbean, Mexico, New Orleans, Nashville, Jamaica and a trip to Disney World. Agency direct support professionals, volunteers, and the participants work to raise the funds necessary for these trips through a variety of fundraising.

For more information about this great program, please contact our Social Recreation Director, Jaimee Scott at JScott@helpinghandsinc.com

	Self	Needs Assistance	Can Not
Hair Brushing
Combing Hair
Toileting - urine
Toileting - bowels
Dresses Self
Buttons/Zippers
Choosing Appropriate Clothing
Knows when to change clothing
Ties own shoes
Makes own bed
Takes care of personal belongings
Can identify a stranger
Can evacuate safety in an emergency
Can utilize a phone for 911

	Yes	No
Friendly/Happy
Cooperative
Has a sense of Humor
Conscientious/Dependable
Enjoys Peer Relationships
Enjoys Staff Relationships
Generally a Loner
Needs/Takes Time for Self
Needs Encouragement to Participate
Combative
Frustrates Easily
Follows Directions
Understands Directions That Require a Decision
Sociable
Can be reasoned with
Will utilize manners appropriately
Enjoys being helpful
Discusses interests, hobbies, family, etc.
Relates well to male authority figures
Relates well to female authority figures
Can the participant read?
Can the participant write?

	Enjoys	Will Watch / May Try	Fearful/Will Not Attempt	Unknown
Swimming/Water Activities
Athletics/Sports
Group Activities/Games
Arts and Crafts
Waling/Nature Activities
Activities with animals (Zoos/Aquariums)
Cooking/Baking Desserts/Snacks
Music Activities
Campfires
Shopping
Down Time
Gambling
Spending Money
Reading
Activities that might get messy

	Yes	No
Is the participant permitted to have cough syrup if necessary?
Is the participant permitted to have Imodium if necessary?
Is the participant permitted to have Benedryl if necessary?

Summer Camp & Shore Program

Shore Weeks

Shore Weeks

Covid-19 Vaccinations are not required but are PREFERRED.

We will be returning to full capacity, which means we will have 10-12 open spots for each Camp & Shore week. Each participant may choose one week of each program, if desired.

Please contact Jaimee Scott for tentative registrations or if you have any questions. The most efficient method is via email. Slots are completely reserved after confirmation is received from Jaimee Scott, Camp Director.

Payment Information

Register Now

Personal Skills Profile

Medication Information

Expectations and Concerns

Permissions

Summer Camp/Shore Vacation Programs Liability Waiver Form

PAY ONLINE AS MUCH OR AS LITTLE AS YOU WANT TOWARDS CAMP!
*All CC payments must be done through PayPal online, not over the phone. Thank you!

Special Vacations Program

Helping Hands Inc.

Directions

Follow us on Facebook!

Summer Camp & Shore Program

Shore Weeks

Shore Weeks

**Covid-19 Vaccinations are not required but are PREFERRED.**

We will be returning to full capacity, which means we will have 10-12 open spots for each Camp & Shore week. Each participant may choose one week of each program, if desired.

Please contact Jaimee Scott for tentative registrations or if you have any questions. The most efficient method is via email. Slots are completely reserved after confirmation is received from Jaimee Scott, Camp Director.

Payment Information

Register Now

Personal Skills Profile

Medication Information

Expectations and Concerns

Permissions

Summer Camp/Shore Vacation Programs Liability Waiver Form

PAY ONLINE AS MUCH OR AS LITTLE AS YOU WANT TOWARDS CAMP! *All CC payments must be done through PayPal online, not over the phone. Thank you!

Special Vacations Program

Helping Hands Inc.

Directions

Follow us on Facebook!

Covid-19 Vaccinations are not required but are PREFERRED.

PAY ONLINE AS MUCH OR AS LITTLE AS YOU WANT TOWARDS CAMP!
*All CC payments must be done through PayPal online, not over the phone. Thank you!