2026 CAMP REGISTRATION

2026 SUMMER LINKS TO LEARNING CAMP REGISTRATION
Camp day runs:
9:30am-12:30pm

Ages:

5 - 12 years

Location:
Cardinal O’Hara High School
39 O’Hara Rd, Tonawanda NY 14150

Payment information:
$375 per week

-- Spots are limited!! --
$50 per week non-refundable deposits are due to hold placement
Full payment must be received by June 15th to guarentee a spot

*Campers should plan to bring a snack each day and to bring their own bike & helmet for bike week, all other supplies provided

*For the safety of our staff and all participants, all children are expected to maintain safe behavior toward both staff and other campers including staying with the group indoors & outside in unfenced areas. Repeated non-compliance with these expectations could result in a call to parents up to and including dismissal from the program.*
Email address*
example@example.com
Please select the week(s) you're registering for:*

Week 1: Bike Riding 101 - July 6-10, 2026Week 2: Fit 4 Fun - Sports, Teamwork, & Fitness - July 13-17, 2026Week 3: Mindful Movers - July 20-24, 2026
Child's Name*

First NameLast Name
Nickname(s)
Preferred pronouns*

he/himshe/herthey/themOther
Parent/responsible adult*

First NameLast Name
Second parent/responsible adult

First NameLast Name
Child's Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone*

Area CodePhone Number
Alternate Phone*

Area CodePhone Number
Date of birth*

MonthDayYear
Date

Emergency contact information*

Rows	First name	Last Name	Phone	Alternate phone	Relationship to child
Primary Emergency Contact
Second Emergency Contact (optional)

Grade entering in September*
School/District*
Does your child currently have an IEP (Individualized Education Plan?)

YesNoUnknown
Does your child receive related services at school? (Physical, occupational, speech therapy, etc.)

YesNoOther
MEDICAL INFORMATION
Vaccinations & Physical

* Copy of recent physical (within 12 months) and vaccination records (DTP, OPV/IPV, HIB, MMR, and Hepatitis B) required prior to start of camp. **** UPLOAD FORMS below or email records to: summercamp@apot-wny.com or fax: 716-874-6175 ****
UPLOAD COPY OF VACCINATION RECORDS

Browse Files

Cancelof
VAX RECEIVED?

YESNOOther
UPLOAD COPY OF RECENT PHYSICAL (completed within 12 months prior)

Browse Files

Cancelof
PHYSICAL RECEIVED?

YESNOOther
Primary Pediatrican *

Provider's NameClinic Name
Pediatrician Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Pediatrician Phone*

Area CodePhone Number
Does your child have any allergies/sensitivities?*

YesNo
If yes, specify allergy/sensitivity*
Has your child ever required medical intervention (medication, EpiPen, urgent care/emergency room visit, etc.) as a result of exposure to an allergen?*

YesNo
If yes, please specify date/details*
Is your child currently prescribed any medications (i.e. inhaler, EpiPen, etc.)?*

YesNoOther
Please list any side effects of medications we should be aware of:
APOT Summer Links to Learning Staff are unable to dispense routine medication to children.

Please contact us with questions:
summercamp@apot-wny.com
Does your child have any dietary restrictions (including allergies)?*

YesNoOther
List dietary restriction*
Does your child have any vision, hearing, mobility, healthcare, or behavioral needs that we should be aware of?*

YesNo
If yes, please explain:*
In the last 12 months, has your child experienced any of the following:*

Bleeding/clotting disorderDiagnosis of heart defect or diseaseHospitalization(s)Respiratory problemsSeizuresSurgeriesDiabetesChicken poxMeaslesAsthmaOther
Does your child have any activity restrictions?*

YesNo
If yes, please explain
Please list any additional medical information the camp should know:
CHILD'S DAILY LIFE

Please complete the following optional information for us to know a little more about our camper(s).
What are your child’s favorite activities?
Does your child require assistance with daily tasks such as eating, going to the bathroom, dressing, climbing stairs, or eating?*

YesNo
If yes, please explain:
Does your child use any assistive devices? (e.g., wheelchair, braces, communication board)*

YesNo
If yes, please explain:
How did you hear about us?*

Previous CamperPrint AdSocial MediaFlyer from schoolAPOT WebsiteKidsOutandAbout.comOther
-- Spots are limited!! --
$50 per week non-refundable deposits are due to hold placements
Full payment due by June 15th

Please contact with any questions/issues with payments:
Summercamp@apot-wny.com
(716) 874-6175

My Products

1 Week Deposit (optional)$50.00

$50 non-refundable deposit per week due to hold placement

Quantity
Item subtotal:$0.00

1 week - Full payment$375.00

$375 per week (full cost) - please select number of weeks you would like to pay in full

Quantity

Total $0.00

Payment Methods

Credit Card

Apple Pay

TOTAL PAYMENT RECEIVED
APOT reserves the right to reschedule, cancel, or offer alternate times for programs to maintain safe staffing to camper ratios. Should APOT need to reschedule, cancel, or offer alternate times, you will be provided with the option for a full refund to be received within 30 days of the notice.
Consent forms & waivers

Please review the attached policies and sign, contact our office with any questions: summercamp@apot-wny.com
Safety considerations:

Our small groups & staffing ratios allow for a significant amount of supervision & support for campers' needs. However, ALL campers are required to remain safe with themselves, staff, and other campers at all times. This means physical & verbal aggression, self injurious behaviors, and unsafe behaviors will not be tolerated. Campers need to be able to stay with the group both indoors & outdoors in unfenced areas. Repeated non-compliance with these expectations could result in a call to parents up to and including dismissal from the program.*
CAMP PICKUP

In an effort to ensure children’s safety, we are going to require that ALL approved adults have identification available to show (driver’s license, photo id, or non-photo id) at the time of pick up for every camper.

Please complete the list below including FULL NAME & PHONE NUMBER for all adults who are approved to pick up your child from camp.

In the event that your child is not picked up by dismissal at 12:30pm, staff may, at their discretion, move down the list and call all approved adults in order to try to secure the camper with transportation home.

To add an additional approved adult to the list to pick up your child, please confirm in writing, in person at the camp, or via email prior to the child being released to the adult.
FULL NAME & PHONE NUMBER FOR ALL ADULTS WHO ARE ALLOWED TO PICKUP YOUR CHILD FROM CAMP*
LIABILITY & PHOTO USE WAIVER

I, as parent/guardian of this child (“Participant”), hereby assume all risks and hazards incidental to the conduct of the activities at the Summer Links to Learning program. My Child is fit for the program in which I have enrolled him/her.
I hereby release and shall defend, indemnify, and hold harmless Associated Physical & Occupational Therapists, PLLC (“Releasee”) from every claim and liability that I or my child may allege against Releasee (including reasonable legal fees and costs), as a direct or indirect result of injury to me or my child because of my child’s participation in the Summer Links to Learning program (“The Program”), whether caused by the negligence of Releasee or others to the maximum extent permitted by law.

I acknowledge that, by signing this document, I am releasing Associated Physical & Occupational Therapists, PLLC and its representatives, agents, employees, volunteers, members, sponsors, promoters, and affiliates from liability. I understand that this form is a contract and it applies to all activities in which my child engages during The Program, regardless of whether such activity is a part of a formal program. I have read this release carefully before signing. I understand what this release means and what I am agreeing to by signing.
PERMISSION TO USE PHOTOS*

I, as parent/guardian, permit Associated Physical & Occupational Therapists, PLLC (“APOT”) to use pictures (to include video photography) of my child(ren) as a Summer Links to Learning program participant for educational purposes, promotional literature, social media, and the APOT website. I understand my child(ren)’s name(s) will not be published.I do not grant permission for use of pictures of my child.
APOT Summer Links to Learning
Cancellation/Refund/Late Fee Policy

APOT’s Summer Links to Learning summer program opportunities require advanced planning including purchasing supplies, insurance, staff training, and preparing the program space. Fees are paid in advance of the event to ensure that we can provide the best service to our participants.

Therefore, the following refund/fee policies are hereby adopted:
    - $50 (per week) non-refundable deposits will be accepted to hold a place in our summer program
            - $375 (per week) total payment is due by June 15, 2026. If full payment is not received by said date, you will be contacted to attempt to collect remaining balance due, if payment is then not received, you will risk losing your spot for that week. Please contact APOT directly (summercamp@apot-wny.com) when registering if you have questions or concerns about payment dates.
- Should you choose to shorten or cancel participation in our program after June 15, 2026, APOT reserves the right to determine refund eligibility or program credit on a case-by-case basis.
            - For the safety of our staff and all participants, all children are expected to adhere to appropriate safety & hygiene guidelines (hand washing, social distancing, safe interaction with staff & campers, using equipment safely), follow staff's instructions, & remain safely within an assigned area. Repeated non-compliance with these regulations could result in a call to parents or dismissal from the program without refund.
            - APOT reserves the right to reschedule, cancel, or offer alternative times for programs to maintain safe staffing ratios and camper support. Should APOT need to reschedule, cancel, or offer alternative times, you will be provided with the option for a full refund (including deposit) to be received within 30 days of the notice.
            - All children are to be dropped off no earlier than 9:30am
  - All children are to be picked up by 12:30pm daily. Our faculty schedules are based on camp needs and meet mandated staff/child ratios. When children are picked up late, it causes hardships for faculty because staff are unable to leave at the end of their scheduled shift. It can also be distressing for children to be left at the camp after hours unexpectedly. Late fees can be assessed when children are picked up after their regularly scheduled time. This fee is $1.00 per minute/per child, enforced at the program’s discretion.
MEDICAL TREATMENT OF A MINOR AUTHORIZATION

ASSOCIATED PHYSICAL & OCCUPATIONAL THERAPISTS has my permission to obtain emergency medical treatment for my child when I cannot be reached or if a delay in reaching my child would be dangerous for him/her. This form grants authority to employees of Associated Physical & Occupational Therapists to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal guardians, and it may not be feasible or practical to contact them.

AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S)

I do hereby grant my authorization and consent for Associated Physical & Occupational Therapists’ employees to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor individual named above.

I authorize said employees to summon any and all professional emergency personnel to attend, transport, and treat the minor individual named above as necessary to preserve the individual’s life, limb, or well-being.

I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of said employees in the exercise of his or her best judgment.
Parent/Legal Guardian Printed Name*
Parent/Legal Guardian Signature: By signing below I do hereby agree to the aforementioned policies & practices & I attest that I am legally responsible for the child registered above*
Date Signed*

MonthDayYear
Date
Should be Empty:

2026 SUMMER LINKS TO LEARNING CAMP REGISTRATION

MEDICAL INFORMATION

Vaccinations & Physical

CHILD'S DAILY LIFE

Payment Methods

Consent forms & waivers

Safety considerations: