Integrity Speech Therapy Summer Camp
Days: July 18, 2022 - August 19, 2022
Address: 3800 North Charles St. Baltimore, MD 21218
Contact us at: 301-337-7893 or marlon@integrityspeechtherapy.com
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Email *
Parent # 1 Name *
Parent #2 Name
Child's Name *
Parent # 1 Cell Phone Number *
Parent # 2 Cell Phone Number
Email *
Child's Date of Birth *
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Does your child currently receive services at Integrity Speech Therapy? *
Has your child received a formal diagnosis or evaluation? If so, what is the formal diagnosis?
What week(s) will your child attend? *
Required
Will your child attend for Full Day or Half Day? *
Tell us about how your child communicates. *
What aspects of communication would you like addressed throughout the week? *
Required
Is your child potty trained? *
Does your child have any allergies? If so, please state. *
Is there anything else you would like us to know about your child?
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