2026 Spark Space Adventure Summer Camp Registration Form

2026 Spark Space Adventure Summer Camp Registration Form
Spark Health at Home, LLC / DBA Spark Therapy

1325 S. Colorado Blvd Suite B312, Denver, CO 80222

(720) 479-8952 | (720) 230-8235

admin@sparkhomehealth.com | welcome@sparktherapycolorado.com

Week 1: July 14-16, 2026 | Week 2: July 21-23, 2026 | 9:00 AM - 12:00 PM
Welcome to Spark Space Adventure!

Blast off to fun this summer with Spark Home Health + Therapy's interdisciplinary summer camp designed to support movement, social engagement, regulation, executive functioning, communication, and play in a fun, inclusive environment.

Children will participate in therapist-led activities including movement games, social groups, crafts, obstacle courses, music experiences, executive functioning activities, and more.

Camp Details

Location:
1355 S. Colorado Blvd, Denver, CO 80222

Empire Park, Building C, Suite 800

Accessible entrance and elevator access available.

Time:
9:00 AM – 12:00 PM

Camp Options:
- Week 1: July 14–16, 2026 (Tuesday–Thursday)
- Week 2: July 21–23, 2026 (Tuesday–Thursday)
- Both Weeks
Ages Served:
Children ages 4–12 years old of all abilities (exceptions may be considered on an individual basis)

Cost (new lower price!):
- One Week: $300
- Both Weeks: $550
Camp tuition includes therapist-led programming, small-group support, camp materials and supplies, activity planning, facility costs, and all camp activities. Our goal is to provide a fun, inclusive, and highly supported experience for every child.

Registration is complete only after payment has been received.

**Enrollment closes Friday July 10th at 6pm**

PARTICIPANT PACKET

Please complete all forms in this packet and return prior to the first day of camp. One packet is required per child per session enrolled. For questions, contact Spark Therapy at (720) 230-8235 or welcome@sparktherapycolorado.com

Participant Registration
Child's Full Legal Name

First NameLast Name
Preferred Name/Nickname:
Date of Birth:

MonthDayYear
Date
Age:
Gender Identity:
Session Enrollment
Please select the summer camp session(s) you would like your child to attend:
Are you enrolling a sibling?
If "Yes," please state the sibling's name:
Reminder: One packet is required per child per session enrolled.
Camp T-Shirt
T-Shirt Size:
Primary Contact / Parent / Guardian
Full Name

First NameLast Name
Relationship to Child:
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Email Address:
example@example.com
Secondary / Emergency Contact
Full Name:

First NameLast Name
Relationship to Child:
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Authorized Pickup Persons (in addition to contacts above)
Name & Relationship (1):
Name & Relationship (2):
Name & Relationship (3):

Diagnoses / Medical History
Please list any diagnoses, medical conditions, or therapeutic needs relevant to camp participation:
Allergies
Does your child have known allergies?

Please list your child's allergens below:

Rows	Allergen	Reaction	Treatment/Epipen?
1
2
3

Current Medications

List all medications your child takes, including OTC supplements.

Child's current medications:

Rows	Medication Name	Dose & Frequency	Condition Treated
1
2
3
4

Medication Policy: For the safety of all participants, camp staff do not administer any medications, including prescription and over-the-counter medications or supplements. If your child requires medication during camp, a parent/guardian will need to come to the camp location to administer the medication.
Please check the box below to acknowledge above medication policy:
Topical Product Authorization

Camp staff may apply the following products if needed.
Spark Therapy will provide sunscreen, insect repellent, and hand sanitizer for camp use. Product brands/types used by camp are listed below.

If you prefer your child use a different product due to allergies, sensitivities, or personal preference, please provide a labeled product for camp staff to use and notify camp staff of any special instructions.
I authorize camp staff to apply the following camp-provided topical products as needed:
If answered "None" above:

Other
Additional instructions and/or allergy information relating to topical products?
Sensory, Behavioral & Support Needs
Please describe any sensory sensitivities, behavioral considerations, communication needs, or therapeutic supports that will help staff best support your child:
Does your child have any history of:

Other
If selected, please provide details:
Please indicate any supports your child may benefit from:

Other
Families are encouraged to send labeled sensory supports such as headphones, chewies, fidgets, or comfort items if needed.
Independence & Bathroom Needs
Is your child fully potty trained?
Can your child independently use a public restroom?
Please provide a labeled change of clothes (shirt, pants/shorts, underwear, and socks) for your child to keep at camp in case of accidents, spills, or messy activities.
Additional bathroom assistance information:
Medical Emergency Authorization
In the event of a medical emergency and I/we cannot be reached, I/we authorize Spark Therapy clinic staff to:

• Call 911 and/or transport my child to the nearest emergency facility.
• Authorize emergency medical treatment deemed necessary by treating medical personnel.

**Our staff will not administer medication.
Primary Care Physician Name:
Practice Name:
Physician Phone:
Please enter a valid phone number.Format: (000) 000-0000.
Preferred Hospital / Facility:
Insurance Carrier:
Policy / Member ID:
Group Number:
Parent / Guardian Signature
Printed Name
Date

MonthDayYear
Date

READ CAREFULLY BEFORE SIGNING. THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS.

I/We, the undersigned parent(s) or legal guardian(s) of the participant named below ("Participant"), in consideration of Spark Therapy, LLC ("Spark Therapy") permitting Participant to attend the Spark Space Adventure Camp program ("Camp"), hereby agree to the following:

1. Assumption of Risk

I/We acknowledge that Camp activities include, but are not limited to: adaptive movement/Zumba, obstacle courses, sensory exploration, fine motor crafts, and social-skills activities. I/We understand that participation in physical activities carries inherent risks of injury, including but not limited to sprains, strains, falls, and other physical harm. I/We voluntarily accept these risks on behalf of Participant.

2. Release of Liability

To the fullest extent permitted by Colorado law, I/We hereby release, waive, discharge, and covenant not to sue Spark Therapy, LLC, its owners, therapists, staff, volunteers, successors, and assigns (collectively, "Released Parties") from any and all claims, demands, losses, or liability arising out of or in connection with Participant's involvement in Camp, including claims arising from the ordinary negligence of Released Parties, except for claims arising from gross negligence, willful misconduct, or conduct otherwise prohibited by Colorado law.

3. Indemnification

I/We agree to indemnify and hold harmless the Released Parties from any claims, actions, damages, or costs (including attorneys' fees) brought by or on behalf of Participant arising from Participant's conduct at Camp.

4. Colorado Statute

This waiver is intended to be as broad and inclusive as permitted by the laws of the State of Colorado, including C.R.S. § 13-22-107. If any portion is held invalid, the remainder of this agreement shall remain in full force and effect.

5. Acknowledgment

I/We have read this release, understand its terms, and sign it voluntarily as my/our own free act. I/We are the parent(s) or legal guardian(s) of Participant and have authority to execute this release on Participant’s behalf.
Participant Full Legal Name:

First NameLast Name
Date of Birth:

MonthDayYear
Date
Parent / Guardian Signature
Printed Name
Date

MonthDayYear
Date
Relationship to Child

Because Spark Space Adventure Camp is therapist-led and serves children of all abilities, staff may use hands-on therapeutic techniques as part of normal program delivery. This form explains and obtains consent for those supports.

Types of Physical Guidance & Therapeutic Support
- Hand-over-hand assistance with fine motor or craft activities
- Proprioceptive and vestibular input (e.g., deep pressure, joint compressions, swinging) as part of sensory integration
- Physical prompting or redirection to ensure safety during movement activities
- Behavioral support strategies consistent with therapists’ professional training (ABA-informed, DIR/Floortime, sensory integration, etc.)
- Positioning or physical assistance to allow full participation in activities
Consent

I/We authorize Spark Therapy therapists and trained staff to use the therapeutic and physical guidance supports described above as professionally indicated to ensure Participant’s safety and full participation in Camp activities. I/We understand I/we may discuss specific limitations or preferences in the Sensory & Support Needs section of Form 2 or by contacting camp staff prior to the start of camp.
Parent / Guardian Signature
Date

MonthDayYear
Date

Spark Therapy, LLC is a covered entity under the Health Insurance Portability and Accountability Act (HIPAA). Health information collected through Camp registration and participation will be treated in accordance with our Notice of Privacy Practices.
- Health information collected for Camp purposes (health history, medications, diagnoses) will be used solely to ensure safe and appropriate program delivery.
- This information will not be shared with third parties except as required by law or as necessary for emergency medical treatment.
- If your child is also a current patient of Spark Therapy, Camp health records are maintained separately from your child’s clinical treatment record.
- A full copy of our Notice of Privacy Practices is available at the front desk or upon request.
By signing below, I/We acknowledge receipt of or access to Spark Therapy’s Notice of Privacy Practices and consent to the use of health information as described above for Camp participation purposes.
Parent / Guardian Signature
Printed Name
Date

MonthDayYear
Date
Relationship to Child

Spark Therapy may photograph or video-record Camp activities for use in clinic marketing materials, social media, newsletters, or training purposes.
Parent / Guardian Signature
Date

MonthDayYear
Date

Payment Information
A member of our administrative team will contact you regarding payment within 3 business days. Registration is complete only after payment has been received.

Thank you for enrolling your child in Spark Space Adventure Summer Camp! We can't wait to blast off into a summer of fun, learning, movement, and connection.
Additional Information
How did you hear about Spark Space Adventure Summer Camp?
If your preferred session is at full capacity, would you like to be placed on the waitlist for possible openings or alternative session availability?
Would you like more information about Spark Home Health + Therapy pediatric speech, occupational, and/or physical therapy services?

Should be Empty:

2026 Spark Space Adventure Summer Camp Registration Form

Welcome to Spark Space Adventure!

Camp Details

**Enrollment closes Friday July 10th at 6pm**

PARTICIPANT PACKET

Participant Registration

Session Enrollment

Camp T-Shirt

Primary Contact / Parent / Guardian

Secondary / Emergency Contact

Authorized Pickup Persons (in addition to contacts above)

Diagnoses / Medical History

Allergies

Current Medications

Topical Product Authorization

Sensory, Behavioral & Support Needs

Independence & Bathroom Needs

Medical Emergency Authorization

1. Assumption of Risk

2. Release of Liability

3. Indemnification

4. Colorado Statute

5. Acknowledgment

Types of Physical Guidance & Therapeutic Support

Consent

Payment Information

Additional Information

Enrollment closes Friday July 10th at 6pm