Camp Dynamics 2024 Application Form
Thank you for applying for Camp Dynamics. Once you have submitted the following information, someone from the DTS team will contact you to schedule your child's screening and/or baseline registration meeting. EVERY camper (including returning campers and current DTS Clients) must complete the intake process so that we can fully prepare for each child to participate in Camp Dynamics. There is a $125 NONREFUNDABLE baseline/registration fee that is required at the time of scheduling in order to confirm your child's baseline appointment**. All campers are also required to have a CURRENT (within the last 9 months) speech and language evaluation ON FILE at DTS in order for DTS to file claims on the child's behalf. If your child does not have a current speech and language evaluation, we are happy to schedule this for you.
**Please note the preregistration camp baselines are for in house use only. The purpose of the baseline is to determine eligibility for camp and to help the #DTSForce to prepare for camp. The camp baseline is NOT a formal evaluation. Any formal documentation requires a full speech and language evaluation. We do not provide a summary or report with our baseline results or share them with parents or other professionals verbally or in written form. If a formal evaluation is needed or required for any reason, parents will need to either schedule at DTS or somewhere else.
How did you hear about us?
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DTS Team Member
Website
Google
Red Stick Mom Blog
BR Parents Magazine or Website
Facebook/Instagram
Friend or Family
Pediatrician or other medical provider
Other
Todays date
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Month
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Day
Year
Date
Primary Caregiver's Information
Full Name (Primary Caregiver)
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Primary Caregiver's First Name
Last Name
Relationship to Camper
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Phone Number
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Please enter a valid phone number.
Email
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example@example.com
Camper Prerequisites
The 5 questions in this section will help you to determine if Camp Dynamics is a good fit for your child.
1. Does your child independently feed himself/herself?
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Yes - My child is FULLY independent with eating.
No - I understand that Camp Dynamics might not be a good fit for my child this summer. I would like to discuss with a DTS team member.
2. Does your child independently use the restroom?
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Yes - My child is FULLY independent with all toileting needs.
No - I understand that Camp Dynamics might not be a good fit for my child this summer. I would like to discuss with a DTS team member.
3. Is your child a danger to themselves or others?
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No - My child is NOT a danger to himself or others.
Yes - I understand that Camp Dynamics might not be a good fit for my child this summer. I would like to discuss with a DTS team member.
4. Does your child ever run away, hit themself or others, and/or throw things in response to being upset?
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NO - My child does not run away, hit themself or others, and/or throw things in response to being upset
YES - My child has in the past run away, hit themself or others, or throw things in response to being upset. However, this is no longer an issue.
YES - My child does run away, hit themself or others, and/or throw things in response to being upset and I understand that Camp Dynamics might not be a good fit for my child this summer. I would like to discuss with a DTS Team Member.
5. Did your child have a behavior plan in place for the 2023-2024 school year?
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NO - My child did not require a behavior plan for the 2023-2024 school year.
YES - My child had a SUCCESSFUL behavior plan in place for the 2023-2024 school year. I would like to discuss with a DTS team member.
YES - My child had an UNSUCCESSFUL behavior plan in place for the 2023-2024 school year. I understand that Camp Dynamics might not be a good fit for my child this summer.
6. Do you have any concerns about your child's ability to be successful at Camp Dynamics this summer?
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NO - I feel confident that my child will be successful at Camp Dynamics this summer
YES - I have some concerns about my child's ability to be successful at Camp Dynamics this summer.
Camper's Information
Camper's Name
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Camper's First Name
Camper's Last Name
Date of Birth
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Month
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Day
Year
Date of Birth
Camper's Age
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School Attended for 2023-2024
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Grade for 2023-2024
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Is your child currently receiving services from DTS?
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Yes
No
Is your child independently reading?
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Yes
No
Does your child have a CURRENT (within the last 9 months) speech and language evaluation?
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Yes. (**Please upload a copy below if not completed at DTS)
No - I will need to have this completed by DTS.
No - I will have our current SLP complete an evaluation.
I will not be utilizing my child's insurance benefits. I understand that a current evaluation will be REQUIRED in order to file claims with my insurance provider and DTS/Camp Dynamics is unable to do this retrospectively.
Does your child have a CURRENT (within the last 9 months) occupational therapy evaluation
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Yes. (**Please upload a copy below if not completed at DTS)
No, but, I am interested in having an OT evaluation completed.
No. I am not interested in OT services at this time.
Speech and Language Evaluation Report - File Upload
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What size t-shirt does your camper wear?
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Youth XS
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Please describe your child's STRENGTHS
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Please describe your child's CHALLENGES
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Please describe any concerns you have regarding your child's social skills/interactions
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Please describe how your child communicates their wants and needs
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Insurance Information
Insurance Carrier
Policy Number
Policy Holder's Name
First Name
Last Name
Policy Holder's Date of Birth
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Month
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Day
Year
Date
Customer Service Number on Back of Insurance Card
Please enter a valid phone number.
When would you like your child to attend Camp Dynamics?
Please select all the weeks you would like your child to attend Camp Dynamics.
Early Registration Discount of $50 ($40 for 4 day weeks) will be applied to each week that is confirmed with a nonrefundable $75 deposit BEFORE May 1.
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Week 1 May 28 - May 31 (Tues - Thurs 8:30-3:30/Friday 8:30-11:30am) $460
Week 2 June 3 - June 7 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 3 June 10 - June 14 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 4 June 17 - June 21 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 5 June 24 - June 28 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 6 July 1 - July 5 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 7 July 8 - July 12 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 8 July 15 - July 19 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 9 July 22 - July 26 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
Week 10 July 29 - Aug 2 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $575
READY to REGISTER?
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Yes. My child is a returning camper/current DTS client. I would like to reserve my child's spot today! Please charge my card on file for the weekly nonrefundable deposit fee of $75 for each week indicated above.
Yes. Once the DTS team completes my child's screening appointment, I would like to reserve my child's spot so we don't miss out! Please charge my card on file for the weekly nonrefundable deposit fee of $75 for each week indicated above.
Not yet. I would like my child to attend the screening and have the opportunity to speak with a DTS team member before reserving my child's spot for each week indicated above. I understand that space is limited and my child's spot is not reserved until my nonrefundable deposits are paid.
Will you need BEFOREcare if it is offered?
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No - 8:30a start time is perfect!
Yes - I am interested in before care EVERYDAY M-F (7:45a-8:30a).
Yes - I am interested in before care but I am not sure which days at this time.
Will you need AFTERcare if it is offered?
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No - 8:30a - 3:30p Mon - Thurs and 8:30a - 11:30a on Fridays is perfect.
Yes - I am interested in aftercare EVERYDAY M-Th (3:30-5:30p)/Fri 11:30a-3:30p
Yes - I am interested in aftercare everyday except Friday (M-Th 3:30-5:30p ONLY).
Yes - I am interested in aftercare on FRIDAYS (11:30a-3:30p) ONLY.
Yes - I am interested in aftercare but I'm not sure exactly which days at this time.
Anything else you want to tell us?
Office Staff Notes Only
Fees Paid?
$125 Baseline Fee
$75 Deposit
$50 Early Deposit
Camp Checklist
Therapist Notified to Screen
Seeking SL/OT Eval
Screening Scheduled
Screening Completed
S/L Eval Needed for Insurance?
Registration Fees Paid
Welcome Pack Sent
Not confirmed
Camp Confirmed
Declined to attend camp
Not a good fit for camp
Thank you!
Someone from the DTS Team will be in touch shortly to schedule your child's screening/registration appointment. We look forward to Lighting Up Learning this summer with your child!
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