2025 MJ Camps Application
Basic Information
Child's Name
*
First Name
Last Name
Child's Birthday
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Can we send text messages to the phone number listed above?
*
Yes
No
Email
*
example@example.com
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How does your child currently communicate?
*
Full sentences
2-3 word phrases
One word verbalizations
Speech generating device (e.g. TouchChat, LAMP, Proloquo)
Sign Language
PECS
Other
Does your child receive private speech and language services?
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Yes
No
Name of facility where speech and language services are provided
Does your child receive ABA services?
*
Yes
No
Name of facility where ABA services provided
Please check off any behaviors that your child demonstrates that should be taken into consideration when grouping your child with others:
Aggressive behavior (e.g. hitting, biting)
Self injurious behavior
Screaming/Yelling
Frequent tanrums
Eloping
Avoidance behaviors
Other
Does your child have any medical diagnoses?
*
Yes
No
If so, what are the medical diagnoses?
Is your child potty trained? If your child is not potty trained, parent will need to be easily contacted for a diaper change during group sessions.
Yes
No
Does your child have any food allergies or sensitivities?
*
Yes
No
If so, please be specific in regard to allergies and/or sensitivities.
Is there any additional information that would be beneficial for us to know?
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MJ Camp Program Selection
All groups are supported by a Speech and Language Pathologist. Please note that space is limited for each group session. Deadline for camp sign up is 3/31. After you complete this application and your MJ Camp selection(s), our clinical team will call you within one week to review the information you provided. From there, you will receive an email or text invoice for a 50% non-refundable deposit per selection (toward camp cost) in order to secure your spot to be paid by 4/30. Remainder of payment is due by 6/1 for June camps and 7/1 for August camps.
Would you prefer to receive requests for payment via email or text message?
*
Email
Text
Signature
*
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AAC Intensive Camp
This group is for children who have a speech generating device and want more socialization opportunities with peers, with using the device. All ages are welcome. This will be an intensive camp for 2.5 hours per day across 4 consecutive days. The cost will be $650.
AAC Intensive Camp
Collingswood Location: June 23-26 9:30- 12pm. All Ages.
Name of AAC Device/App
Skill level with communication device
Beginner
Intermediate
Advanced
Summer Social Groups
This group will focus on language and socialization skills with peers for children ages 3-5 and 6-9. This group will meet once weekly for an 1.5 hours across 4 weeks. The cost will be $375.
Summer Social Groups
Marlton Location: 9:30-11:00 am Mondays August 4-25. Ages 3-5
Collingswood Location: 10:30-12pm Mondays August 4-25. Ages 6-9
Picky Eating Groups
Please note, Picky Eating Groups are only open to current MJ Kidz patients. If you are not a current patient, but would like to be evaluated, please contact our office. This group is for children who consume a limited number of foods. Your child may have a sensory aversion to food based on the texture, color, shape, brand or/and size. Ages 3+. This group will be run on a daily basis for 4 consecutive days at 2.5 hours per day. The cost will be $650.
Picky Eater Camp
Marlton Location: August 18-August 21 9:30-12 pm. Ages 3+
Swedesboro Location: June 23-June 26 9:30-12 pm. Ages 3+
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