TDCC Summer Camp 2025 Registration

Summer Camp 2025 Registration
Child's Name*

First NameLast Name
MaleFemale
Date of Birth*

DayMonthYear
Date
Address*
Mother*

NamePhone Number
Father*

NamePhone Number
Contact Email Address*
example@example.com
Dietary Requirements*

Medical Condition: The following special health problems should be noted and adequate precautions taken (list such items as: usually severe reactions to bee stings, other severe allergies, haemophilia, diabetes, heart disease, etc.)*

	Health Issue	Reaction	Medical Response required
1
2

If medication is required to be administered by a Centre nurse, during Centre hours, a duplicate copy of the prescription is mandatory. The following medication/ prescription is required: *

	Medical Prescription	Dosage	Time	Specific Instructions
1
2

Drop off/ collection from TDCC:

	Name	Phone number	Relation to the Child
1
2

Emergency Contact*

	Name	Phone number	Relation to the Child
1
2

Language spoken at home*
First language*
Is your child dry during the day?*

YesNo
Can your child feed themselves?*

YesNo
Does your child attend nursery or school?*

YesNo
If yes, name of nursery or school?*
Write N/A if not applicable
Does your child have a diagnosis?*

YesNo
If yes, kindly specify:*
Write N/A if not applicable
Grade level?*
Type of program*

Mainstream EducationSpecial Education
Services Received at School (if any):

Resource RoomTherapy1:1 Learning Support / ShadowOther
Does your child see any health professionals?*

YesNo
If yes, type of health professional*
How is your child's behavior at nursery / school?*
How is your child behavior at home?*
How do you manage the behaviors?*
What would you like us to focus on during the program?*
List of preferred activities? *
List of activities to avoid? (messy play , water play , bubbles, etc)*
Does your child talk? (verbal)*

YesNo
If no, how does your child communicate:

Gesture / SignPullingPointingPictures
Please check your registration options (Mon - Thu 9 am to 1 pm and Fri 9 am to 12 pm) :*

Week 1 (Jul 07th to Jul 11th)Week 2 (Jul 14th to Jul 18th)Week 3 (Jul 21st to Jul 25th)Week 4 (Jul 28th to Aug 01st)Week 5 (Aug 04th to Aug 08th)Week 6 (Aug 11th to Aug 15th)
Weekly rate: AED 1800 per child

Terms and conditions: Fees are due within five days of receipt of registration. This fee is not refundable.
How did you hear about the program?*
Name and Signature*
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