2025 Kindergarten Readiness
Please complete this form so you can be added to the waitlist for Kindergarten Readiness!
Name of Child
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
My child is currently on an IEP
*
Yes
No
If your child is currently on a IEP, please write in what supports they are receiving. If your child is not currently receiving a IEP please write in N/A.
*
What areas of concern do you have with your child going into Kindergarten?
I want my child to attend the following session/s. 9:00am-11:00am
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June 9th-June 27th
July 7th-Aug 8th
Both
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Withdrawn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
None
Other
Our current adult to child ratio is approximately 1:4. Will your child need additional support?
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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
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Yes
No
What do you hope to gain from the Kindergarten Readiness?
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 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.
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
*
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
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!
Kindergarten Readiness - The cost for our Kindergarten Readiness program is $240 for a four-week session. If you choose to prepay for both four-week sessions, you will receive a discounted rate of $450. This fee is nonrefundable and also covers the cost of supplies, program materials, shirts, water bottles, and other essentials. Missed classes are nonrefundable. A $50 deposit is required to hold your spot and will be applied to your total cost. A invoice will be sent to the provided email with the remainder of your balance.
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