Is your child:* A returning camper A new camper Child's Name*Date of Birth*MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parents' Names*Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* Allergies/Special AlertsChild's Diagnosis (if known)School Name*Grade*What services (if any) does your child currently receive in school?How does your child engage in small groups?*Is your child able to feed him/herself?* Yes No Is your child toilet trained?* Yes No If yes, how does your child let you know s/he needs to use the bathroom?*What does your child like to play with?*How does your child manage frustration/anger?*Which camp session(s) are you interested in?* Session 1 (July 29 - August 2, 2024) Session 2 (August 5 - August 9, 2024) Session 3 (August 12 - August 16, 2024) Not sure yet Thank you for your interest! We will get back to you as soon as possible to set up a screening. Δ