2025- TLS Summer Camp
Registration opens to the public March 3
How many students are you registering for?
*
Please Select
1
2
3
4
Is your child a current TLS student?
Yes
No
Student 1 Name
*
First Name
Last Name
Age
*
Grade Level
*
T-shirt Size
*
Please Select
YS
YM
YL
S
M
L
XL
2X
Student 2 Name
*
First Name
Last Name
Age
*
Grade Level
*
T-Shirt Size
*
Please Select
YS
YM
YL
S
M
L
XL
2X
Student 3 Name
*
First Name
Last Name
Age
*
Grade Level
*
T-Shirt Size
*
Please Select
YS
YM
YL
S
M
L
XL
2X
Student 4 Name
*
First Name
Last Name
Age
*
Grade Level
*
T-Shirt Size
*
Please Select
YS
YM
YL
S
M
L
XL
2X
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Student Drop Off / Pick Up At Respective Site
Drop Off 9:00 AM Pick Up 3:00 PM
Site Attending
*
TLS Central- Worthington
TLS South - Canal Winchester
TLS Northeast - Johnstown
Registration options: If both apply, please select both options
*
$3,000 -Registration
$400 - Peer Registration; Classroom Peer Modeling (Limited Spots)
Payment
Email Carmella Bojarzin to discuss payment options cbojarzin@thelearningspectrum.com
Funding Source (Total camp cost is $3000)
*
Autism Scholarship *
Susan Mosure Scholarship (TLS only)*
Franklin County Pilot Program*
Credit Card
Check
District*
*For those who qualify
Contact Carmella Bojarzin for more information on payment options at cbojarzin@thelearningspectrum.com
Important Information
***TLS BEHAVIOR CLAUSE: In order to ensure a safe and effective learning enviroment, The Learning Spectrum asks that student's behavior be manageable independently in a small group setting. Your child's 1:1 support may attend if your child has their own provider.
Enrollment for camp will be finalized May 1, 2025.
Camp spots and funding are on a first come, first serve basis.
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EMERGENCY CONTACT INFORMATION
Parent/Guardian Information
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Emergency Contacts
Name
*
Name
Relationship to child
Phone Number
*
Please enter a valid phone number.
Name
*
Name
Relationship to child:
Phone Number
*
Please enter a valid phone number.
Authorization is hereby given to The Learning Spectrum staff to release the above named child to thefollowing persons, provided proper identification:
Name & Relationship
*
Name
Relationship
Name & Relationship
*
Name
Relationship
Name & Relationship
*
Name
Relationship
Physician to be notified in an emergency:
*
Physician's Name
Phone
Diet restrictions and additional medical information
I, the undersigned, authorize the staff at The Learning Spectrum to take what emergency medical measuresare deemed necessary for the care and protection of my child enrolled at The Learning Spectrum.
Signature
*
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Media Release
I, the undersigned, do hereby deny or grant permission to The Learning Spectrum to use the image of my child, as marked by my selection(s) below. Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of my child for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on The Learning Spectrum Website.
Type a question
*
Deny permission to use my child’s image at all. (Excludes Class Dojo and Yearbook)
Grant permission: I give unrestricted permission for my child’s image to be used in print, video, and digital media (including our social media pages). I agree that these images may be used by The Learning Spectrum for a variety of purposes and that these images may be used without further notifying me. I do understand that the child’s last name will not be used in conjunction with any video or digital images.
Signature
*
Date
*
-
Month
-
Day
Year
Date
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