Every Child Plays

Camp Application

Parent and Child Information

Parent/Caregiver Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Child's Name

First Name

Last Name

Child's Date of Birth

YYYY

Child's Current Grade Level

What is your child's primary language? (If multilingual, please list all languages your child speaks at home).

General Needs and Abilities

Tell us about your child’s strengths.

What areas or challenges does your child need additional support in to thrive throughout their day?

Health and Safety

Does your child have a formal diagnosis from a medical professional?

If yes, please describe:

Does your child have any allergies or dietary restrictions?

If yes, please specify:

Additional Information

Has your child successfully participated in a full-day drop-off program before?

Would your child have reliable transportation to be dropped off at 9:00am and picked up promptly by 4:00pm all 3 days of camp?

I am applying for:

Thanksgiving Break - November 24, 25 and 26

Winter Break - December 29, 30 and January 2

We are available for either camp

Would your child be able to attend all 3 days of this camp?

Is there anything else you would like us to know about your child to help us provide the best experience for them?

How did you hear about this program?