KUBO Little Innovators (3-6 yrs) SUMMER CAMPS Program Application
Thank you for your interest in our STEM Social programs! Please fill out the application below and we will contact you soon regarding more information or to help finalize your registration to the program that fits your child's interests and needs best. 

SURREY (Cloverdale Library) (Ages 4-7 yrs):


VANCOUVER (KUBO Centre) (Ages 3-6 yrs & Ages 7 - 9 yrs):



*If you would like to only sign up for specific dates within July and August, please add that request in the additional comment/question section below

Sign in to Google to save your progress. Learn more
Email *
Parent's Name  *
Child's Name & Pronouns  *
Child's Age *
Child's Diagnosis (if any; e.g., Autism, ADHD, Down Syndrome, FASD, Developmental Disability, etc.) *
Which camp location are you registering for?  *
Is your child able to follow 1-step directions?  *
Can your child communicate vocally or with AAC device (ask for wants/needs, respond yes/no, short phrases)?  *
Is your child independent in a variety of self-help routines (e.g., toileting, dressing)?  *
Does your child engage in any high risk aggression/self-injurious behaviours or is a flight risk?  *
Does your child have any health/safety concerns? If yes, please specify *
What support ratio would your child benefit from ? (1 adult : # student[s]) *
What are your child's interests? (E.g., interested in Minecraft, LEGO, etc.) *
What are their social goals? (E.g., initiating social connections, engaging in conversation/commenting w/ peers, finding other peers with similar interests to connect with, etc.) *
Is there any other information you would like to share regarding your child?
For JULY WEEKLY CAMPS - which weeks would you like to apply for?  (Please check description above for specific dates & times per week & location) *
Required
For AUGUST WEEKLY CAMPS - which weeks would you like to apply for?  (Please check description above for specific dates per week & location) *
Required
Would you like to register your child for longer camp hours? If so, please select the number of hours you would like to add on each week. If you'd only like extended hours for specific dates, please select 'other' and specify dates and additional hours 
Clear selection
Would you like to register a sibling? (5% off the lower-priced enrollment when two siblings register for the same camp week).
Clear selection
Do you have any other comments or questions for our team? 
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Daniela Marco Behaviour Consulting.

Does this form look suspicious? Report

Google Forms