2019 Summer Camp New Camper Application
Thank you for your interest in Miriam Summer Camps! Please submit this form indicating which camp(s) you are considering, along with the required documentation outlined below. This application is required for placement consideration in Miriam summer camps. RETURNING CAMPERS should contact Gail Porter (firstname.lastname@example.org) to request the camp(s) of your choice.
Submission of the application is not a guarantee of camp acceptance.
Feel free to contact us at 314-961-1500 with any questions regarding this process.
Click here to view the 2019 Summer Camp Brochure
Session 1: June 10-21, 2019
Session 2: June 24-July 5, 2019 (No Camp July 4)
Session 3: July 8-19, 2019
Educational info is required for ALL children being considered for camp acceptance.
Please send the required documents to us (see below) in one of the following ways:
314-968-7338 Please write "Miriam Summer Camps" on the fax cover sheet OR
Miriam Summer Camps
501 Bacon Avenue
St. Louis, MO 63119
For children who have Educational Service Plans, please send us:
1) A copy of the FULL Evaluation Report that determined the service plan, and
2) A copy of the FULL Service Plan - whichever applies (IEP, ISP, IFSP, 504, etc.)
For children WHO DO NOT have any of the above service plans, please send us
1) Report Card or Progress Report
2) Standardized test scores
Authorization to Release/Receive Confidential Information
I understand that by completing the information below and submitting this form, I am giving permission to release/receive the designated confidential information for one year from the date of my electronic signature. I understand that I may withdraw this permission at any time during the period by stating the request in writing.
ALL INFORMATION WILL BE KEPT CONFIDENTIAL AND USED SOLELY FOR ADMISSION PURPOSES
Information from teacher questionnaires will also be used to determine camp appropriateness and placement. Please list 2 TEACHER CONTACTS from your child's current school who are most familiar with your child's daily routine/performance. This is required information.
Application for admission is considered without regard to race, sex, age, religion, or ethnic origin.