Summer Camp 2019
Please complete form to apply for camp. You will be contacted upon receiving application.
Email address *
Parent's Name *
Your answer
Summer Session *
Required
Best Contact Number *
Your answer
Child's First Name *
Your answer
Child's Age *
Your answer
His/Her Diagnosis *
Your answer
Briefly describe your child's social difficulties. *
Your answer
Check off services your child is receiving in and/or outside of school.
Additional Comments
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