Camp Kim4Kids Registration

Camp Kim4Kids Registration

Join Camp Kim4Kids for two weeks of therapist-led fun! Campers will build confidence and develop motor, communication, and daily living skills through engaging OT, PT, and ST activities. Choose Week 1, Week 2, or both, and customize your child's experience with optional Before Care, After Care, and the Bike Riding Clinic.
Child Information
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Grade Entering Fall 2026
Child's School
Parent / Guardian and Emergency Contact
Parent / Guardian Name

First NameLast Name
Parent / Guardian Email
example@example.com
Parent / Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Camp Week Selection and Add-Ons
Camp week(s)
Add-ons (Week 1)
Add-ons (Week 2)
Add-ons (Week 1 & 2)
Add-ons (Week 3)
Additional Add-on
Week 3 Add-On
Beforecare (8:00–9:00 AM) is available. Due to therapist scheduling, Aftercare will not be available during Week 3.

Bike Riding Clinic Add-On (Optional)
Note: Enrollment in After Care is required to participate in the Bike Riding Clinic. Campers will transition from after care to their bike session and then return to after care afterward.
Bike Riding Clinic Add-On
Time Slot (Week 1)
Time Slot (Week 2)
Aftecare Therapy Interest

Take advantage of the Aftercare time (12:00–2:30 PM) for individualized Occupational Therapy or Speech Therapy focused on your child's specific goals, such as handwriting, fine motor skills, school readiness, reading, language.
Would you be interested in additional one-on-one therapy sessions during After Care?
If yes, which service(s) are you interested in? (Select all that apply.)
What would you like your child to work on? (Optional)

Other
Health, Permission, and Consent
Food allergies / Dietary Notes
Diagnoses or needs we should know about
Does Kim4Kids have permission to take photos/videos of your child to be used for marketing purposes including social media posts
Parent / Guardian Signature / Consent to Participate

Sign to give consent to participate.
Total Registration Fee

Payment Amount

USDDescription

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Camp Kim4Kids Registration

Child Information

Parent / Guardian and Emergency Contact

Camp Week Selection and Add-Ons

Aftecare Therapy Interest

Health, Permission, and Consent

Payment Amount*

Payment Amount