T4K Camp Registration
Therapy 4 Kids Summer Camp Registration 
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Child's Full Name  *
Parent or legal guardian's full name  *
Date of Birth  *
MM
/
DD
/
YYYY
Gender  *
Address *
Phone Number  *
Email address  *
June 19-23
July 17-21
Do you have any motor, speech, feeding or sensory concerns?  *
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