2025 Summer Camp Registration FORM
Please complete this form so you can be added to the list 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.
*
Meridian
Emmett
Parma
Select the preferred time. Group times are 2 hours at the following camps: Meridian and Kuna. Group times are 3 hours at the following camps: Parma and Emmett.
*
Morning
Afternoon
Either time
Below are the day/group times at the Meridian camp. If you have selected the Meridian camp please pick the age/group time that is preferred. (Please note that if your child currently receives therapy, your camp days will need to be on different days from your current therapy days)
M/W, 9:00-11:00, Ages 3-4
M/W, 2:00-4:00, Ages 3-4
M/W, 12:00-2:00, Ages 5-7
T/TH, 9:00-11:00, Ages 5-7
T/TH, 12:00-2:00, Ages 7-10
T/TH, 12:00-2:00, Ages 5-7
T/TH, 2:00-4:00, Ages 5-7
T/TH, 2:00-4:00, Ages 10 and up
I want my child to attend the following session/s
*
June 9th-July 11th (week of 6/30-7/4 off)
July 14th-Aug 8th
Both
I am interested in my child receiving the following services:
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Speech Therapy
Occupational Therapy
My child currently receives the following services at We are Better Together, School or another location:
*
Speech Therapy
Occupational Therapy
Not Currently Receiving Services
If your child is currently receiving services, please write in where they are receiving services. If your child is not currently receiving services please write in N/A.
*
If your child is currently receiving services, please write what day/days they are receiving services. If your child is not currently receiving services please write in N/A.
*
What age group are you interested in?
*
Preschool 3-4
Young child 5-7
Child 8-10
Pre-Teen 11-12
How does your child communicate?
*
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Withdrawn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?
*
Yes
No
I acknowledge that if my child needs additional support, that I will be able to provide it
*
Yes
Is your child potty trained
*
Yes
No
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
I acknowledge that this is not a free service. I understand that my insurance/Medicaid will be billed for services received.
*
I acknowledge
I would like to use my Empowering Parent grant
*
Yes
No
Does not apply
Caregiver/Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Best way to contact you
*
Email
Phone
Other
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any allergies? If no, type "None" in the box below
*
Shirt Size
*
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
How did you find out about our camp? If it was from one of our staff please write in the staff members name.
Exciting things are coming your way! Keep an eye on your inbox for an email with all the details on what's next in your summer camp journey!
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. This is a nonrefundable fee. Weekly therapy sessions are covered by insurance or Medicaid. Copays/coinsurance will apply.
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USD
Supply and T Shirt Fee.
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
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