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Camper Referral 2021 - Therapist/Professional

Therapist/Professional Form

Camper Referral 2021 – Therapist/Professional

Camper Referral 2021 - Therapist/Professional

For therapist and/or professional (OT, COTA, PT, PTA, SLP, SLP aide, TVI, O&M certified, D/HoH support) of child being referred for potential participation in Bay Cliff Health Camp for summer 2021. Complete this form and submit, or you have the option (at the bottom of the form) to save and return later. All fields marked with * are mandatory. You will get an immediate notification of receipt (or link to access later). If you don't, please reach out to Bay Cliff Health Camp for support (906)345-9314 or jpinar@baycliff.org
  • (ex. MS, OTRL - TVI - PT, DPT - etc)
  • We will only phone you for questions specific to this child/this summer, after trying the email provided.
    Check any service that the child has currently. This will help Bay Cliff make sure we get professional servicer information to best inform therapy and camp services this summer.
  • Eligibility

    Bay Cliff Health Camp has developed a set of criteria to determine if children will be successful in our typical summer program. The entire criteria are available on our website, and several key indicators are included below. Check each box that is correct (aka the child 'is', 'does' or 'has') and add any notes necessary for clarification at the bottom.
  • Information for therapists at Bay Cliff

  • (or indicate if you are aware that the family/child has a piece of equipment to use).
  • If 'yes' was indicated for swallowing difficulty
  • If 'yes' was indicated for difficulty swallowing.
  • If 'yes' was indicated for medical precautions
  • Recommendations

    for therapist/professional at Bay Cliff Health Camp this summer!
  • Drop files here or
    Accepted file types: jpg, png, pdf, .
    IEP and recent progress report.
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later
Theresa Campana2021-01-22T14:56:10-05:00

N4175 County Road KCA, P.O. Box 310, Big Bay, MI 49808    |    baycliff@baycliff.org    |    (906) 345-9314    |    Fax: (906) 345-9890

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