Dream Day Holiday Weekend 2019
December 6-8, 2019 at the Doubletree Hilton Hyannis, MA. Applications will be accepted on a first come first served basis with preference given to first-time attendees. Please note that Dream Day serves immediate family members only (Required PCA/aide acceptable.) Deadline for application is OCTOBER 31, 2019. Families will be notified beginning November 1st, 2019. Please visit www.dreamdayoncapecod.org for more information or email info@dreamdayoncapecod.org.
Email address *
Parent(s) or Guardian LAST Name *
Your answer
Parent(s) or Guardian FIRST Names *
Your answer
House Number and Street Name (only) *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email Contact *
Your answer
Best Phone Contact Number
Your answer
Child's Last Name *
Your answer
Child's First Name *
Your answer
Diagnosis *
Your answer
Year and Age of Diagnosis *
Your answer
Child's Age *
Your answer
Child's Primary Language *
Your answer
Can He/She Speak English? *
Would your family need a wheelchair accessible room? *
Will attendance by your PCA or other aide be required? *
Please list all siblings (under 18) who will be attending. Include Full Name, Age, and Gender *
Your answer
How many family members IN TOTAL will be attending (please include a PCA/aide if attendance required) *
Your answer
Please tell us any information we should know about your family (This may include questions or concerns you have.)
Your answer
Have you ever attended the Holiday Weekend before? *
If you answered yes above, please provide year(s) of attendance.
Your answer
How did you hear about Dream Day? *
From above, if you checked healthcare provider, hospital or social service agency, please list including name of contact (so that Dream Day may provide them with additional information to help other families.) Thank you!
Your answer
Have you attended our summer camp? *
If you answered yes above, please provide year(s) of attendance at summer camp.
Your answer
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