Camp Registration Form
Speech-Language Pathology Summer Camp
Which camp are you registering for?
*
Speak Now Camp, August 3-7th, 2026
Connections: A Summer Growth Experience for Neurodivergent Learners at SEU - July 27- 31st, 2026
Both camps
Child’s Name
*
First Name
Last Name
Name of person completing this form
*
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child
*
Date of Birth of Child
*
-
Month
-
Day
Year
Date
Age
*
Grade
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Questions?
Please reach out and contact the Speech Language Pathology Clinic at (973) 290- 4264
Submit
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