Description

Thank you for your interest in our upcoming summer camp! Please register below to save your child’s spot. If you are within the first 30 campers to receive our discounted grant price, you will receive an email with a coupon code within 24 hours of completing the registration form below (excluding holidays and weekends):

Child Name *

First

Last

Child Age *

Grade Entering for 2025-2026 year *

School Attending *

Gender *

Male
Female
Prefer Not to Answer

Is your child on the autism spectrum? *

Please list all additional diagnoses here if applicable:

Is your child a peer mentor? *

Does your child require 1:1 support? *

yes
no
depends on activity

Is your child potty trained? *

How did you hear about us? *

Parent / Guardian Name *

First

Last

Email *

Phone *

Emergency Contact Name and phone number *

Does your child require medication to be administered during camp hours? *

Does your child have any food allergies? *

yes (if so, please list under 'additional info' section that follows)
no

Is your child non-verbal? *

Yes (if so, please detail communication devices used under 'additional info' section below:
No
Third Choice

Additional Info You'd Like To Share:

Please upload a copy of your child's most recent physical form for our records *

Click or drag a file to this area to upload.

*Please note grant funds are available only to families paying directly for services. In the event we are offering a complimentary camp or reduced registration fee, you may be charged an additional fee if your child requires 1:1 support to accommodate additional staffing needs. Thank you for your understanding as we grow to accommodate more campers.

Additional information

Number of Days	1, 2, 3, 4, 5

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