2024 Summer Camp Registration FORM
Please complete this form so you can be added to the waitlist for summer camps!
Name of Child
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Interested Group Location - Days may be subject to change based on space and therapists availability. UPDATED 6/12/24
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WAITLIST ONLY! Meridian (Tuesday/Wednesday/Thursday &/or Friday)
WAITLIST ONLY! Caldwell (Monday/Wednesday)
WAITLIST ONLY! Parma (Wednesday/Thursday)
WAITLIST ONLY! Emmett (Monday/Tuesday)
Best time for group - Exact group times are currently TBD based on space, location and therapist availability. Most group times will range from 1.0-2.0 hours long.
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Morning
Afternoon
Either time
I am interested in my child receiving the following services:
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Speech Therapy
Occupational Therapy
Physical Therapy
My child currently receives the following services at We are Better Together, School or another location:
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Speech Therapy
Occupational Therapy
Physical Therapy
Not Currently Receiving Services
What age group are you interested in?
*
Preschool 3-4
Young child 5-7
Child 8-10
Pre-Teen 11-12
I want my child to attend the following session/s
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July 8th-Aug 1st
How does your child communicate?
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Non verbal
Gestures
Single words
Short phrases
Sentences
Engages in conversations
Other
Diagnoses:
*
No diagnosis
Autism Spectrum Disorder
ADHD
Speech/Language Delay
Down Syndrome
Cerebral Palsy
Cognitive Impairment/Developmental Delay
Other
Challenges: Please check the following challenges that describe your child
Anxious
Withdrawn
Rigid
Impulsive
Verbally aggressive
Physically aggressive
Distracted/distracting to others
Oppositional
Our current adult to child ratio is approximately 1:4. Will your child need additional support?
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Yes
No
If your child will need additional support, do you have a support worker, care giveer or family member to assist your child?
*
Yes
No
NA
What do you hope to gain from the summer group?
Conversational skills (greetings, initiates, eye contact, engaging, staying on topic, interrupting)
Making friends
Play skills (turn taking, initiating, sustained play, following rules, sportsmanship)
Practice using or increasing Speech/Language Skills
Practice using or increasing Occupational Therapy Skills (Fine motor, sensory, etc)
Other
Caregiver/Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Best way to contact you
*
Email
Phone
Other
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Does your child have any allergies? If no, type "None" in the box below
*
Type a question
*
Child Size (4)
Child (5-6)
Child (7-8)
Child Size (9-10)
Child Size (10-12)
Child Size (14-16)
Adult Small
Adult Medium
Adult Large
Adult X Large
Camp Registration Fee - There will be a $25.00 registration fee for summer camp this year to cover cost of supplies, shirts, water bottles, etc.
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USD
There will be a $25 registration fee for summer camp this year.
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
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