Sign me up for POTS Camp 2024

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WHO: Children ages 4-6

WHEN: Week 1: 8/19-8/22 | Week 2: 8/26-8/29
HOURS: 9:00 AM - 12:30 PM Mon - Thurs.
WHERE: Pediatric Occupational Therapy Services
1415 Queen Anne Road, Teaneck, NJ 07666
FEES: $500.00 per week

Please fill out one form per child

Email *

Child's Name *

Child's Date of Birth *

YYYY

I am interested in: *

Week 1: 8/19-8/22

Week 2: 8/26-8/29

Required

My child is entering... *

Pre-K

Kindergarten

First Grade

Other

Parent's Name *

Parent's Cellphone *

Emergency Contact Name *

Emergency Contact Phone Number *

What are your goals for your child? *

I give permission for photos of my child to be taken for
*

Albums/emails that are sent to all camp participants

POTS website/social media

Required

Please check to indicate your agreement with our policies *

A non-refundable deposit of $200.00 per week is due upon registration to hold your spot.

I will email office@potsot.com or call 201-837-9993 to provide my billing Information

Full payment is due by June 3, 2024. No refunds for any reason.

If I haven't been a client of POTS in the past 12 months, I agree to bring my child for a brief interview.

Insurance does not reimburse for camps and POTS does not provide a super bill.

I have read and accepted the above terms

Required

Any other information you would like to share?

Submit

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