MI - Summer Programs

Parent / Guardian Information

Use this form to sign up for Summer Programs in Troy, Michigan.
First Name*
Last Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

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Postal / Zip Code

Child's Information
Name

First NameLast Name
Birth Date

MonthDayYear
Date
Grade Level
Gender
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.

Emergency Contact Information
Name*

First NameLast Name
Relationship*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alt. Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Individuals Other than Parent/Guardian Authorization

Only these individuals have my authorization to care for my child in the event of an emergency and/or for drop-off and pick-up. Please advise these individuals they are authorized and will need to present identification to staff.
Name*

First NameLast Name
Relationship*
Name*

First NameLast Name
Relationship*

Informed Consent and Acknowledgement Waiver*
Medical Release and Authorization*
Informed Consent and Acknowledgement Waiver
Informed Consent and Acknowledgement Waiver*
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Parent/Guardian Signature*

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Please select your camp(s)
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Sensory Explorers Summer Camp (Wednesdays & Fridays, July 10 - Aug. 16
Ages: 4-6 years old. Campers will have fun with different themes each week while learning strategies for: Sensory regulation Improving body awareness How to get the “just right” sensory input Sensory-Motor integration Emotional regulations

$480.00

Executive Functioning Development Summer Camp (Mondays & Fridays, July 10 - Aug. 16
Ages: 8-12 years old. At the Executive Functioning Skill Development Camp, campers will learn strategies for: Self-monitoring and emotional regulation Time management Attention optimization Flexible thinking

$480.00

Total

$0.00

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