Spring Camp 2024 Registration

Child's Name*

First NameLast Name

MaleFemale

Date of Birth*

Date

Address*

Mother*

NamePhone Number

Father*

NamePhone Number

Contact Email Address*

example@example.com

Dietary Requirements*

Medical Information: The following special health problems should be noted and adequate precautions taken (list such items as: usually severe reaction to bee stings, other severe allergies, haemophilia, diabetes, heart disease, etc.)*

	Health Problem	Reaction	Medical Response required
1
2
3

If medication is required to be administered a centre nurse, during centre hours, a duplicate copy of the prescription is mandatory. The following medications/ prescriptions are required:

Medication:*

	Medication Prescription	Dosage	Time	Specific Instruction
1
2
3

Drop off/ collection from TDCC*

	Name	Phone Number	Relation to the child
1
2
3

Emergency Contact*

	Name	Phone Number	Relation to the child
1
2

Language spoken at home*

First language*

Is your child dry during the day?*

YesNo

Can your child feed themselves?*

YesNo

Does your child attend nursery or school?*

YesNo

If yes, name of nursery or school?*

Grade level?*

Type of program*

Mainstream EducationSpecial Education

Does your child has a diagnosis?*

YesNo

If yes, kindly specify*

Services Received at School (if any):*

Resource RoomTherapy1:1 Learning Support / ShadowOther

Does your child see any health professionals?*

YesNo

If yes, type of health professional*

How is your child's behavior at nursery / school?*

How is your child behavior at home?*

How do you manage the behaviors?*

What are would you like us to focus on during the program?*

List preferred activities? *

List activities to avoid? (messy play , water play , bubbles, etc)*

Does your child talk? (verbal)*

YesNo

If no, how does your child communicate:

Gesture / SignPullingPointingPictures

Please check your registration options (Mon to Thu - 9:00 am to 1:00 pm, Fri - 9 am to 12 pm):

Week 1 (March 25th to March 29th)Week 2 (April 01st to April 05th)

Weekly rate: AED 1800 per child

Terms and conditions: Fees are due within five days of receipt of registration. This fee is not refundable.

How did you hear about the program?*

Name and Signature*