Summer Camp 2019 - If this is your first time registering for a Spectrum Insights event, please contact the director to arrange for an interview:
info@spectruminsights.ca
613.2205920
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Email address
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Your email
2019 Summer Camp registration - Boys and Girls camp, Just For Girls and Moving Forward.
Students Name:
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Your answer
Please note: Our programs are comprised of and best suited to students "classically" diagnosed with Aspergers or FASD, ADHD, PDD-NOS and a mild learning disability. That being said, we teach Social and Life skills to any student who wants to learn how to be more independent and make new friends. Students should be able to have reciprocal conversations, take direction handle transitions and able to self regulate.
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I Understand
Date of Birth
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Mixed Boys and Girls Camp - Check the weeks you want your child to attend. The camp is $452/week - includes all activity fees and OC Transpo Bus passes
July 8-12 4 spots
July 15 - 19 2 spots
July 22 - 26 1 spot
July 29 - August 2 - FULL
August 5 - 9 (includes the holiday Monday) FULL
August 12 - 16 - FULL
Just For Girls - Check the week you want your child to attend. The camp is $452/week - includes all activity fees and OC Transpo Bus passes
July 15-19
August 12-16
Moving Forward for adults - Check the week you want your child to attend. The camp is $452/week - includes all activity fees and OC Transpo Bus passes
July 8-12
August 5-9 (includes the holiday Monday)
Parents or Guardians Name(s)
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Your answer
Medical Concerns / Conditions
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Your answer
Contact info. Your contact details and contact details in case of emergency. Please include names and phone numbers.
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Your answer
Do you consent to your child leaving the camp on their own?
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Yes
No
Other:
Photo Permission - Any photos/videos taken may be used to help promote and document the activities of Spectrum Insights events through our website, Facebook, Twitter and Instagram. Names and personal information of the students WILL NOT be used.
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Yes I give permission for my child to be photographed
No I do not give permission for my child to be photographed
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Dietary restrictions
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None
Vegetarian
Vegan
Kosher
Gluten-free
Other:
I understand that a non refundable deposit of $200 per week booked or full payment, $452, guarantees my child a spot at summer camp. We will not be reimbursing for missed days. The deposit is NOT an additional fee, it is part of the total payment. Final Payment ($252) to be made on the first week (Mon) of your child's camp. If you prefer, full payment can be made at the completion of this form via cash, cheque or EFT and sent to the Program Director. Cheques can be made out to: John Anderson 316 Robillard pvt Ottawa, ON K1T 2V8. EFT's to
John@spectruminsights.ca
. Please note that students with ASD can be changeable when it comes social groups, if you feel your child cannot commit to our camp, then please reconsider joining as refunds are not given. We will do out best to encourage and motivate your child should he/she become anxious about attending. Our camps are meant to be fun, laid back and make social experiences a lot easier.
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I understand and I agree. I will pay the deposit - $200
I understand and agree. I prefer to pay the full fee - $452
I understand and agree - I have already paid the deposit
I understand and agree - I have already paid the full fee
I understand and agree - Payment as previously Discussed with the director
Waiver: It is my understanding that an activity of this nature has inherent risks involved. All reasonable precautions for the safety and health of the participant will be taken. He/she will be properly supervised in activities. In the event of accident or sickness, Spectrum Insights, sunnyside Weslyan Church, its staff and volunteers are released from any liability. In the event of injury requiring medical attention, I authorize treatment for the participant and understand that reasonable attempts will be made to contact me, should such a situation occur. Please note this group is not appropriate for any aggressive behaviours or students that may potentially run off. Students must be able to exhibit independence and ability to follow complex group instruction.
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I Understand and agree
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By typing my name below, I confirm that I have read and understood the Registration Form. I also confirm that the information I have provided on this form is true, correct, and complete.
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