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RISE & SHINE Kidz Camp Registration
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Kidz Name
*
Your answer
Nickname they prefer (if any)
Your answer
Age and grade they just finished
*
Your answer
Birthdate - mm/dd/year
*
Your answer
What week/weeks do you want to register your Kidz for?
June 7
June 14
June 21
June 28
July 5
July 12
July 19
July 26
Preferred method of payment?
*
Check
Invoice and pay online
Drop off will be 8:45-9am. Pick up 4:45-5pm. Does this work for you?
Yes
No
Set up specific time
Clear selection
Parent Name
*
Your answer
Email Address
*
Your answer
Phone number
*
Your answer
Which do you prefer:
*
Call
Text
Either
Relationship to Kidz
*
Your answer
Emergency Contact Information
Please use information of who will be in charge of dropping/picking up kidz.
Name
*
Your answer
Relationship to Kidz
*
Your answer
Phone Number
*
Your answer
Camp Requirements: Please check the box for confirmation of acknowledgement
Wear workout clothes (breathable, comfortable, close-toed CLEAN tennis shoes)
No medication disbursements
Bring a water bottle
Electronics: (we will have opportunities for short electronic breaks)
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Yes, my child is allowed designated electronic time during Kidz Camp
No, my child will not have an electronic device during Kidz Camp
If yes to 'Electronics', what device will they be responsible for while at Kidz Camp?
*
Your answer
Help us get to know your Kidz!
Any info you can give us the more helpful it is to the Camp Director and Counselors
Does your Kidz have any allergies we need to be aware of?
*
Your answer
Are there any food/drinks your Kidz may NOT have?
*
Your answer
What are the best ways to help them reset? (overwhelm, fatigue, emotional)
*
Your answer
How can we help if they lose focus?
*
Your answer
Does your Kidz have any specific triggers? (loud noises, bright lights, shouting/yelling)
*
Your answer
If yes, what would be the best way to help? (headphones or sunglasses)
*
Your answer
Any specific Challenges we need to be aware of?
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Your answer
What does your Kidz like? Hobbies/Arts and Crafts/Skills/Favorite Foods
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Your answer
What are some good incentives that we can give to help them be successful? (Stickers, snacks, songs they like to listen to/types of music)
*
Your answer
What is the “for sure thing” that makes your Kidz smile?
*
Your answer
Are there any physical/verbal cues or things they like as positive reinforcement? (high-fives)
*
Your answer
Is there anything else you need or want to tell us about your Kidz?
*
Your answer
Thank you for choosing RISE & SHINE Kidz Camp!
We are so looking forward to a great summer!
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