Camp 2024 Registration

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Child Information

Name

First

Last

Date of Birth

Grade

Gender

T-shirt size

Holds an IEP/IFSP/504 plan

Does the child have a speech and language evaluation report available that is 2 years or newer?

Does the child have any allergies, chronic illnesses or medical conditions? If yes, please describe

Does the child have an educational diagnosis (ie. ADHD, ASD etc)

Sessions attending

Session 2: July 8-12
Session 3: July 15-19
Session 4: July 22-26

Is the child potty trained? (required to attend camp)

Parent/Guardian Information

Name

First

Last

Email

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Authorized Pick up & Emergency Contact

Name

First

Last

Phone

Name

First

Last

Phone

Join Us Today

Take the first step towards enhancing your child’s speech and language development journey. Contact us now to schedule an assessment.