Red Hook Day Camp
Interest Form
Email address *
Caregiver Information
Name
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Address Line 1 *
Your answer
Address Line 2
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Child Information
The following section gives us a better sense of your child's needs.
Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
What in school supports does your child receive? *
Disability / Diagnosis *
Toileting skills *
Communication style *
What are your child's interests? How do they like to play? *
Your answer
What are you hoping for your child to get out of attending summer camp? *
Your answer
Which weeks of camp are you interested in having your child attend? *
Required
Is your household income below $25,000 annually? *
Does your family qualify for any of the benefits below? *
Required
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