SayPro Therapeutic Camp: Participant Registration Form.

Welcome to the SayPro Development 5-Day Therapeutic Camp!
This registration form is designed to gather essential details about participants to ensure that we provide therapeutic activities tailored to meet your specific needs. The information collected here will help our team understand your therapeutic goals, previous treatments, and any special requirements, so we can make the camp experience as beneficial as possible.

Please complete the form below in detail. All information provided will be kept confidential and used solely for the purpose of planning and delivering the most effective therapeutic program for you.

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Participant Information

1. Full Name:
   First Name: _________
   Last Name: _________
2. Date of Birth:
   MM/DD/YYYY: _________
3. Gender:
   ☐ Male
   ☐ Female
   ☐ Non-binary
   ☐ Prefer not to answer
   ☐ Other: _________
4. Contact Information:
   Phone Number: _________
   Email Address: _________
5. Emergency Contact:
   Full Name: _________
   Relationship: _________
   Phone Number: _________

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Health Information

6. Primary Diagnosis/Condition:
   Please specify the condition(s) you are seeking therapeutic support for:
7. Do you have any specific therapeutic needs?
   Please describe any physical, mental, or emotional challenges you are currently experiencing that we should be aware of:
8. Previous Treatments and Therapies:
   Have you previously participated in any therapeutic treatments or programs? If yes, please list them along with the approximate dates:
9. Current Medication:
   Please list any medications you are currently taking (include dosage and frequency):
10. Medical History:
    Are there any other relevant medical conditions or health concerns we should be aware of (e.g., allergies, previous surgeries, chronic conditions)?
    ☐ Yes (Please specify): ________________
    ☐ No
11. Special Dietary Requirements or Restrictions:
    Do you have any dietary needs that we should accommodate? (e.g., vegetarian, gluten-free, allergies)
    ☐ Yes (Please specify): ________________
    ☐ No
12. Mobility or Physical Limitations:
    Do you require any mobility aids (e.g., wheelchair, crutches) or have physical limitations that need special consideration during the camp?
    ☐ Yes (Please specify): ________________
    ☐ No

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Therapeutic Goals and Expectations

13. What are your primary goals for attending the SayPro 5-Day Therapeutic Camp?
    Please describe what you hope to achieve during the camp:
14. What specific therapeutic activities or treatments would you be interested in?
    (e.g., physical therapy, emotional support, group therapy, art therapy, mindfulness practices, etc.)
15. Any concerns or preferences regarding your therapeutic experience?
    Are there any specific approaches, methods, or therapeutic strategies you would like to prioritize or avoid?

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Consent and Acknowledgement

16. Informed Consent:
    By submitting this form, I acknowledge that I have provided accurate information to the best of my knowledge and consent to the use of this information for the planning and delivery of my therapeutic activities at the SayPro 5-Day Therapeutic Camp. I understand that participation in therapeutic activities may involve physical or emotional challenges, and I am fully aware of the potential risks involved. Signature: _______________________
    Date: _______________________
17. Medical Consent:
    In the event of an emergency, I authorize the camp staff to seek medical attention on my behalf if necessary, and I will bear responsibility for any costs incurred in seeking such treatment. Signature: _______________________
    Date: _______________________

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Additional Information

18. How did you hear about the SayPro Therapeutic Camp?
    ☐ Referral from a healthcare provider
    ☐ Online Search
    ☐ Social Media
    ☐ Word of Mouth
    ☐ Other (Please specify): ________________
19. Do you have any additional comments or questions regarding the camp?

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Camp Schedule and Preparation

• Camp Dates: January (Specific dates provided upon registration confirmation)
• Camp Location: [Provide Address and Venue Details]
• What to Bring: Comfortable clothing, personal items (medications, toiletries), any required mobility aids, etc.

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Thank you for registering for the SayPro 5-Day Therapeutic Camp.
We look forward to supporting your journey towards better health and well-being through a personalized therapeutic experience. Our team will review your responses and be in touch with you shortly to confirm your registration and provide further details.

If you have any questions, please feel free to contact us at [Insert Contact Information].