Camp Leap in 2026 registration form

Summer Camp Registration 2026!

Camp Leap IN is hosted by Senses Therapies LLC of NC . Camp hours: Monday - Thursday 9:00-12:00 at Canterbury School 5400 Old Lake Jeanette Rd. Greensboro NC 27455
All weeks for Camp Leap in are on a wait list- If you would like to be added to the wait list please indicate which week(s) below.
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade/School currently attending
Gender
T shirt size
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Tuition information and cancellation policy:

Cost for Camp is $325 per week. Your camp fee is due in full at the time of registration to reserve your spot. Applications will be reviewed individually and you will be notified if your child has been accepted into Camp Leap In.

Camp Cancellation policy:

Cancellation requests need to be received via email to Tiffany:

tiffany@sensestherapies.org

Refunds will be issued for cancellations prior to April 1. After that date, a partial refund will only be given if that camper's spot can be filled. This refund will be in the amount of $200, and a $100 processing fee will be retained.
By checking the boxes below, you are indicating all statements to be true:
Please tell us about your child! Sensory issues, communication, strengths/needs, social skills, motor skills, and anything else that you think we need to know about your child.
Does your child have any allergies or special dietary restrictions? Please explain in detail below. Any medical conditions/medications that we need to be aware of?
Informed Consent and Medical release/ Acknowledgement

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the provision of necessary medical services in the event that my child is injured or becomes ill. I understand that Camp Leap In will not be responsible for the medical expenses incurred in such instance, but that these expenses will be my responsibility as the parent/guardian.

Camp Leap in and its affiliates are not responsible for lost or damaged personal property.
Media Release

I hereby give permission for my child to be photographed and or videoed at Camp Leap In. I understand the photos/videos will be used to keep a journal of activities, to share with parents and share during presenations to Donors of Camp Leap In. These photographs may be used for promotional purposes including: flyers/brochures, and social media.

I understand that although my child's photograph/video may be used for advertising, his/her identity will NOT be disclosed, and I do not expect compensation. All photos and videos are the property of Camp Leap In and its affiliates.
Media Release statement: Please indicate your choice below.
Payment options - please check your payment preference below. Payment must be received in full for your spot to be reserved.
Class Wallet policy:

Families who choose to use their Class Wallet to pay for camp tuition are responsible for ensuring that all camp fees are paid in full by June 15, 2026. If the full camp tuition has not been successfully paid through the Class Wallet by this date, the family will be required to pay the entire camp fee out of pocket to secure their child’s enrollment.

If a family decides to withdraw from camp after June 15, 2026 due to unpaid Camp Wallet funds, camp tuition will still be due, as a spot has been reserved for the child for approximately five months. However, if the camp is able to fill the withdrawn spot with a child from the waiting list, the family will not be required to submit payment.

This policy helps ensure fair enrollment practices and allows the camp to plan staffing, materials, and programming appropriately
Confirmation

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.

IN SIGNING BELOW I AM AGREEING TO ALL TERMS OF THE REGISTRATION INCLUDING CAMPER REQUIREMENTS AND ALL LIABILTY STATEMENTS.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty:

Summer Camp Registration 2026!