Summer 2021 Handwriting Camp Registration
Join this four-week fun-filled, interactive handwriting camp (printing and cursive writing) open to all students! This camp works to improve:

• Gross and fine motor skills
• Sensory Processing
• Visual Processing Skills
• Attention Span
• Self-esteem and confidence
• Upper body strength

Instructed by Licensed Occupational Therapist Nicole Koranda OTR/L

For additional information and/or questions, please contact:

Nicole Koranda, OTR/L
nicole@keikitherapy.com
808-209-7934

* An email invoice will be sent within 48 hours after the registration form has been completed below *

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Printing (suggested 1st - 3rd Grade)
Classes on Mondays
June 7, 14, 21, 28
9:00 - 10:00 am

4 classes for $150, includes booklet and supplies
Limit of 6 students per class
Cursive Handwriting (suggested 3rd - 5th Grade)
Classes on Mondays
June 7, 14, 21, 28
10:15 - 11:15 am

4 classes for $150, includes booklet and supplies
Limit of 6 students per class
Registration Information
Pick A Camp Class *
Student Name *
Student Gender *
Student Grade (starting Fall 2021) *
Parent/Guardian Name *
Parent/Guardian Phone *
(mobile)
Email Address *
Student camper agrees to safety protocols *
Student camper agrees to wash hands in the clinic upon arrival, wear facemask at all times, and social distance with other campers.
Required
Liability Release *
By enrolling the student named above in Handwriting Camp and allowing named student to participate in the activities associated with Handwriting Camp, I, the parent/guardian, being the legal and acting guardians of the student, acting for myself and/or on behalf of the student, release and hold harmless Keiki Therapy, LLC, Nicole Koranda OTR/L and/or volunteers from any and all liability, claims, demands, actions and causes of action whatsoever, arising out of or related to any loss, property damage, or personal injury, including death, that may be sustained by the student and/or the undersigned, while in or on the premises upon which the program is conducted, or incurred while in or on any premises under the control or supervision of Nicole Koranda OTR/L and/or volunteers, or incurred while enroute to or from any said premises, or incurred while on any other premises or place while participating in activities of whatever kind or nature related to the activities of Keiki Therapy, LLC and Nicole Koranda OTR/L.
General Information
• Handwriting Camps are designed for all children and do not require a doctor’s order for participation.

• Camps are not considered therapy and the fees are not billed to insurance.

• Camps are taught using the Handwriting Without Tears curriculum. Fees include all workbooks and consumable supplies needed for class activities.

• Children must be able to participate in a small group setting for 1 hour and attend to activities as structured for the duration of the class without direct one to one assistance.

• All fees for Handwriting Camp are due prior to the first date of the class.

• No refund is offered for individual missed sessions.

• Each Handwriting Camp session must have a minimum enrollment in order to be held. The sessions are filled on a first-come basis and will close when the maximum enrollment has been met. A waitlist will be kept.

• Full refunds are provided in the event of session cancellation due to a lack of enrollment. Participants will be notified no later than 5 days prior to the first date of camp if a session must be canceled.
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