2026 Mid-Ohio ESC Summer Camp

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Please complete this registration for the participating student no later than Friday, May 8th, 2026, 4:00pm. Please provide the email of the district representative registering the student directly below.

Email *

Please enter the first and last name of the student you are registering.

What grade will this student be attending the in fall of 2026? *

Please list the students date of birth, address, parent phone number. Parent, Guardian and Emergency Contact Information, email

What service needs does this student have for ESY on their IEP?

Medical/Nurse

Occupational Therapy

Registered Behavior Technician / BCBA

Speech - Language Therapy

Physical Therapy

Other:

What School District will purchase a seat for this student?

Ashland City

Ashland County Community Academy

Bucyrus

Clear Fork

Crestline

Crestview

Foundation Academy

Galion

GOAL

Highland

Hillsdale

Lexington

Lucas

Madison

Mansfield Christian School

Mansfield City

Mount Gilead

Northmor

Pioneer

Plymouth-Shiloh

St. Mary of the Snows

St. Peter's Catholic Schol

Fredericktown Local

Richland School of Academic Arts

Other:

What other information would be helpful for us to know about this student?

Please send the student's IEP and/or 504 document to martin.michaela@moesc.net

Yes

N/A

Send me a copy of my responses.

Submit

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