SunKids 2018 Application
Please complete the form below to apply for SunKids 2018. Submit before May 11th for the Early Bird Discount. Email SunKids organizers Tammy Mitchell and Mark Kim at sunkids@centerfordevelopingkids.com with any questions regarding the program or application.
Contact Information
Child's Name *
Your answer
Child's Date of Birth *
MM
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DD
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YYYY
Caregivers' Names *
Your answer
Address *
Your answer
Email *
Please note that communication will primarily be conducted through email.
Your answer
Best Phone Number *
Your answer
SunKids Registration
Times: Monday through Thursday, 1-4pm
Cost: $475 per week ($400 Early Bird Registration before May 11th)
$75 one-time, non-refundable registration fee
Please select the week(s) you would like your child to attend SunKids. *
While the structure of the program remains consistent week to week, each week has varied activities and crafts.
Required
FUNDING *
Please select a payment method for SunKids Summer Program. Payments are due in full by June 22rd.
Required
If you selected Regional Center, please specify: *
Registration Fee *
A $75 non-refundable fee is required to complete registration and reserve a spot in the group.
Please select all that apply:
Enrollment Policies and Consent Forms
Reference Form
Please download the document titled "Reference Form" from the Summer Programs page of our website and have it completed by a teacher or therapist who has experience working with your child in a group setting. After completed, mail, fax, or email to SunKids organizers at Center for Developing Kids (see contact information below). We will need to have this form before we can secure a spot for your child in SunKids.

200 E. Del Mar Blvd. Suite 112
Pasadena, CA 91105
Fax: (626) 564-2770
sunkids@centerfordevelopingkids.com

Consent for Release of Information *
Center for Developing Kids, Inc. has my permission to contact the person who completes the reference form to discuss my child's ability to participate in a group program.
Persons authorized to pick up your child from Center for Developing Kids: *
Please list the name, relationship to the child, and phone number of any individual who has permission to pick up your child from SunKids other than the caregivers listed above.
Your answer
Consent to Photograph *
This is to authorize Center for Developing Kids to use any pictures/tapes/videos/films taken of my child or myself, with my full knowledge and consent as a client of Center for Developing Kids. This visual record may be used for public relations, marketing, and/or teaching and training activities and/or as part of my child's medical/developmental record, as Center for Developing Kids may deem proper. If used for any purpose outside of the child's medical/developmental record, all identifying information will be removed. Center for Developing Kids is hereby relieved and released of all responsibility or claims in regard to the above.
Enrollment Policy *
Registration forms and payment are due in full to Center for Developing Kids by May 11, 2018, for Early Bird Registration, or by June 22, 2018, for regular registration. Caregivers are responsible for contacting Regional Center to arrange funding, if applicable. This form is an application and does not guarantee enrollment in SunKids. I understand that children need a completed reference form from a teacher or therapist to be considered for SunKids. Caregivers will be contacted if their child is accepted into the program. Childrens' participation may be interrupted if they are not successfully engaged in the program within the first 3 days. In these instances, the child will not be able to continue in SunKids. Missed days are not eligible for refunds or makeups. I understand there is a $1/minute late fee for pickups after 4 pm. I give permission for my child to participate in sensory motor, craft, and cooking activities. In case of emergency, I understand Center for Developing Kids staff will secure treatment by calling for an ambulance or paramedic to treat my child and/or transport my child to the emergency hospital. Center for Developing Kids is released of any financial obligation for treatment/transport in this event.
Participant Information
How did you hear about SunKids Summer Program? *
Required
If other, please indicate below.
Your answer
What are your child's interests and strengths? *
(e.g. puzzles, ball games, books, animals, music, etc.)
Your answer
How does your child perform in a group of 4-5 children? *
Your answer
What tends to make your child upset, irritated, dysregulated? *
Your answer
What helps your child calm when he or she is upset? *
Your answer
How does your child communicate to get his or her needs met? *
Your answer
Is your child potty trained? If so, at what level? *
Your answer
List any and all allergies, medications and/or special dietary needs of your child: *
Your answer
Primary Care Physician *
Please list your child's primary care physician, along with their phone number, in case we need to contact them in an emergency.
Your answer
Is there anything else you would like to tell us about your child? *
Your answer
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