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TLS Summer Camp 2016
DUE BY MARCH 17th
2016 Summer Camp Registration
Monday-Thursday 9am-3pm June 13, 2016- July 21, 2016
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* Indicates required question
Age Group
*
Preschool/ Toddler (5 years and below)
School Agers (6-12)
Teens (13 and up)
Respite *Only available during camp weeks (All Ages)
Individual Education Services (All Ages)
Required
Special Needs/ Peer Rates
*
Choose
Special Needs Preschool / Toddler $3,000
Preschool/ Toddler Peer $800
Special Needs School Agers $3,000
School Agers Peer $800
Special Needs Teens $3,000
Teens $800
Option 7
RESPITE
*
Yes I Need Respite
No I do NOT Need Respite
RESPITE RATES
*
Morning Respite $10/ day
Afternoon Respite $15/hour
BOTH Morning and Afternoon Respite
N/A
Child Name / DOB
*
Your answer
Parent/ Guardian
*
Your answer
Address
*
Your answer
Email
*
Your answer
Location Desired
*
Central (Worthington) FULL - REGISTRATION CLOSED
South (Canal) FULL- REGISTRATION CLOSED
East (Newark)
North (Sunbury)
Amount Due
*
Your answer
Payment Source
*
Waiver (CANALand NEWARK ONLY) *CENTRAL / WORTHINGTON & SUNBURY - FULL
Autism Scholarship
Private Pay
Insurance
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