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Mighty Minds Summer Week
This form is used to register for the 2024 Mighty Minds Summer Week. Please fill out the form and our staff will contact you to answer any questions!
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* Indicates required question
Email
*
Your email
Child's Name:
*
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Parent/Guardian Name
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Parent/Guardian Email address
*
Your answer
What week are you interested in registering your child for?
*
July 8-12th
July 29th- August 2nd
Both
I'm not sure yet
Grade completed as of June 2023
*
Choose
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
What school does your child attend?
*
Your answer
What are you hoping your child gets out of this summer program?
Your answer
If you would like us to look into insurance coverage, please include insurance company, child's member ID, and the policy holders name and date of birth. We currently accept Husky, Aetna, Anthem, Cigna, Harvard Pilgrim, Connecticare, United Healthcare, and Optum.
If your child has husky there is no cost for this service. The cost varies for other insurance policies. We are happy to look up your specific policy to determine the out of pocket cost for your child.
*Please note your child must have a related diagnosis to bill insurance for this service and coverage varies depending on the policy.
Your answer
Will you be available at 11am on the last day of the week in order to participate in the parent wrap up?
Yes
No
I dont know yet
No but I would like to participate virtually, if possible
No but I plan to send a different adult/caretaker
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