Camp Dynamics 2025 Application Form

Camp Dynamics 2025 Application Form

Please complete the form below to begin the application process for Camp Dynamics. Once submitted, someone from our team will review your responses and contact you within 48 hours to provide additional information about Camp Dynamics and our registration process. Please note, submission of this form DOES NOT guarantee your child's spot at Camp Dynamics.
How did you hear about Camp Dynamics?*

BR Parents Magazine or WebsiteDTS EmailDTS Team MemberFacebook/InstagramFriend or FamilyGooglePediatrician or other medical providerRed Stick MomWebsiteOther
Todays date*

MonthDayYear
Date
Primary Caregiver's Information:
Full Name (Primary Caregiver)*

Primary Caregiver's First NameLast Name
Relationship to Camper*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Please indicate the best days/times for our team to contact you:*
Camper's Information:
Camper's Name*

Camper's First NameCamper's Last Name
Date of Birth*

MonthDayYear
Date of Birth
School Attended for 2024-2025*
Grade for 2024-2025 *
What type of classroom is your child currently enrolled in? *
Please describe your child's classroom: *
Camp Dynamics is appropriate for children ages 4-12 years old. However, DTS intends to offer alternative summer programs for younger children. Is your child UNDER the age of four?*

YesNo
Is your child currently receiving services from DTS?*

YesNo
Insurance Claim Requirements

In some instances, Camp Dynamics can be billed through your insurance. To process claims, we require a current speech-language evaluation, which can be completed by our team or submitted to us by your child's current speech-language pathologist. Dynamic Therapy Specialists is in-network with Aetna, Blue Cross Blue Shield, and WebTPA (LSU First). All other insurance providers, including Medicaid, will be subject to private pay rates. Please note, that while we are an in-network provider with WebTPA, they rarely approve claims for Camp Dynamics.
Do you have Blue Cross Blue Shield or Aetna insurance?*

YesNo
Insurance Carrier*
Policy Number*
Name of Policy Holder*

First NameLast Name
Does your child have a current (within the last 9 months) speech and language evaluation?*

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 that this must be completed BEFORE my child attends Camp Dynamics.
Does your child have a CURRENT (within the last 9 months) occupational therapy evaluation*

Yes. (Please upload a copy below if not completed at DTS)No, but, I am interested in having an OT evaluation completed so that my child may benefit from this service as part of their Camp Dynamics experience.No, I am not interested in OT services at this time.
Evaluation Report(s) - File Upload

** Please note that psychoeducational reports and IEPs often do not contain the necessary information required to file Camp with your insurance. This informtaion is still helpful for our team to review, however, additional evaluations may be required.
Cancelof
Camp Dynamics Information and Prerequisites:

Camp Dynamics is a group-based, therapeutic environment facilitated by Dynamic Therapy Specialists' team of Speech-Language Pathologists, Occupational Therapists, Audiologists, and support staff. Camp Dynamics allows children to engage in fun activities throughout the day while also learning how to organize their bodies for improved focus and attention, learning, and behavior. Our primary goal is to provide children with opportunities to be independent, flexible thinkers in a peer-based setting!

While our team is confident that they can help all children succeed, the group nature of Camp Dynamics necessitates that children be mostly independent with certain skills. The following questions will assist our team in determining how we can best support your child this summer.
1. Can your child independently feed himself/herself?*

YES, my child is fully indepenent with feeding themselves.NO, my child requires assistance with feeding. I recognize that Camp Dynamics may not be a good fit for my child for this reason.
Please share more about what areas of feeding your child requires assistance with:*
2. Can your child independently use the restroom (including but not limited to: independently recognizing the need to use the restroom, wiping, and personal hygeine)?*

YES, my child is fully independent with all toileting needs.NO, my child requires assistance with toileting. I recognize that Camp Dynamics may not be a good fit for my child for this reason.
Please share more about what areas of toileting your child requires assistance with:*
3. Does your child ever run away, hit themself or others, and/or throw things when upset?*

NO, my child does not run away, hit themself or others, and/or throw things when upset.YES, my child has in the past run away, hit themself or others, or throw things when upset; however, this is no longer an issue.YES, my child currently runs away, hits themselves or others, and/or throws things when upset. I recognize that Camp Dynamics may not be a good fit for my child for this reason.
Please share more about how your child responds when they are upset, including any known triggering events:*
4. Did your child require a behavior plan or individual behavioral support for the 2024-2025 school year?*

NO, my child did not require a behavior plan for the 2024-2025 school year.YES, My child had a behavior plan and/or required individual behavioral support for the 2024-2025 school year. I recognize that Camp Dynamics may not be a good fit for my child for this reason.
Please share more about your child's behavioral needs this school year, including whether their behavior plan was successful or unsuccessful: *
5. Is your child independently reading?*

YES, my child is independently reading.NO, my child is not independently reading at this time. This is NOT a prerequisite for admittance to Camp Dynamics.
6. Based on the above information and pre-requisite questions, do you have any concerns with your child's ability to be successful*

No, I feel confident that my child will be sucessful at Camp Dynamics!Yes, I have concerns about my child's ability to be successful at Camp Dynamics.
Please share any concerns you have related to your child's participation at Camp Dymamics: *
Tell us more about your child:
Please describe your child's STRENGTHS:*
Please describe your child's CHALLENGES:*
Please describe how your child interacts with peers and in social situations:*
Please describe how your child communicates their wants and needs:*
Is there anything else you would like us to know about your child?*
When would you like your child to attend Camp Dynamics?

Select all the weeks you would like your child to attend Camp Dynamics. The fees listed below are private pay rates. We can verify your insurance and provide a quote based on your coverage.
Get a $50 discount ($40 for 4-day weeks) on each week of camp when you confirm your spot with a nonrefundable $100 deposit per week by May 2. *Indicates 4 day week.*

Week 1 May 27 - May 30* (Tues - Thurs 8:30-3:30/Friday 8:30-11:30am) $550Week 2 June 2 - June 6 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 3 June 9 - June 13 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 4 June 16 - June 20 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 5 June 23 - June 27 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 6 June 30 - July 3* (Mon - Thurs 8:30-3:30) $550Week 7 July 7 - July 11 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 8 July 14 - July 18 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 9 July 21 - July 25 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650Week 10 July 28 - Aug 1 (Mon - Thurs 8:30-3:30/Friday 8:30-11:30am) $650
We do offer before and aftercare for an additional fee. Would you like to learn more about this service?*

YesNo
Thank you!

Someone from the DTS Team will contact you within 48 hours.
Should be Empty:

Camp Dynamics 2025 Application Form

Primary Caregiver's Information:

Camper's Information:

Insurance Claim Requirements

Tell us more about your child:

When would you like your child to attend Camp Dynamics?

Thank you!