Summer Camp 2019
Please complete form to apply for camp. You will be contacted upon receiving application.
* Required
Email address
*
Your email
Parent's Name
*
Your answer
Summer Session
*
Session I June 17th - June 20th
Session II July 15th - July 18th
Session III August 12th - August 15th
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.
One to One ABA Instruction
Counseling
Social Skills Group
Speech Therapy
Occupational Therapy
Physical Therapy
Other:
Additional Comments
Your answer
Send me a copy of my responses.
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