Summer Camp Priority Registration

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We are excited to offer several summer camps for the Summer of 2022.

ALL children are welcome-you do NOT have to be a Connect Pediatric Therapy family

Thank you in advance for completing this form! Once you have submitted your Registration Form, you will be placed on our priority list to be contacted via email when we release our camp dates in March of 2022. You will receive priority registration.

No payment due now-payment will be collected at time of registration.

Contact (402) 413-1356 with questions.

Camps will fill on a first some first serve basis.

Note: Connect Pediatric Occupational Therapy has completed and signed the HIPAA Business Associate Agreement in G Suite which protects Patient Health Information (PHI) submitted through this form.

Email *

Parent's name *

Parent phone number

Child's name *

Child's Date of Birth *

YYYY

Which camp(s) are you interested in: *

Superheroes of Self Regulation (Ages 4-6 and 7-12)

Handwriting-Printing Power (Ages 1st-4th grade)

Handwriting: Learning to Write (Pre-K-1st grade)

Handwriting-Cursive (Age: 3rd grade-7th grade)

Food with Friends (all ages)

Other:

Required

Any other questions or concerns?

Submit

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