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Waiting List Application Form
Parent's Names *
Phone Number *
Date *
MM
/
DD
/
YYYY
Email *
Mailing Address *
Child's First and Last Name *
Gender
Clear selection
Does a sibling already attend camp? *
Current School Attending *
Current Grade Level *
Age *
Areas of Disability
Please check all that apply: (To qualify for camp, individual must have at least one) *
Required
Primary Goal *
In 250 words or less, please provide a brief description of your child's strengths and needs (i.e. verbal/nonverbal, toilet trained, socially motivated, eats with assistance). Include any specific concerns you may have (communication, behavior, or other).
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