Summer Camp Registration Form

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Nutcracker Therapy Summer Camp will run from July 1st to August 23rd, 2024 (eight weeks in total). The program will be designed by a BCBA and taught by interventionists, located at 650 HWY 7 East, Unit 301, Richmond Hill.

Each of the eight weeks will feature different learning themes, providing children with the opportunity to learn various skills through ABA teaching, such as social skills, emotional management, exploration of interests and hobbies, physical activity, conversation, and academics.

The camp will operate Monday to Friday, from 9:00 am to 4:00 pm each day.

For those enrolling continuously for all eight weeks, the price is $1000 per week. If opting for half-day sessions or non-consecutive weeks within the eight-week period, the price is $1100 per week or $550 for half-day (morning or afternoon) sessions.

Email *

Child's Name *

The Child's Date of Birth *

YYYY

Parent's Name *

Email *

Phone Number *

The Child's OAP Number (if applicable)

I intent to register my child for *

8 weeks (from July 2 to August 23)

All mornings

All afternoons

Non consecutive weeks during this 8-weeks period (please specify in the next section)

Other:

Required

If you are registering non-consecutive weeks during the 8 weeks period, please indicate the weeks that you are planning to register: *

What is the child's current communication level? *

non-vocal; using points, gestures, pulls

non-vocal; using communication apps

communicate in one word

communicate in 2-3 words or phrases

communicate in full sentences

Other:

Required

Any Challenging Behaviors? *

difficult transitions, e.g., from preferred activities to non preferred activities

gets upset if preferred items are removed

access to attention e.g., laughing, running away, making faces and looking at the other person's eyes

SIB (self injured behaviors)

aggressive behaviors toward others

My child is very chill and relaxed most of the time, no major behavioral issues

Other:

Required

I understand the camp fees as follows: If you enroll continuously for eight weeks, the price is $1000 per week; if you opt for half-day sessions or non-consecutive weeks within the eight-week period, the price is $1100 per week or $550 for half-day (morning or afternoon) sessions. *

Yes

Required

I understand that this is only an intent form for registration; in order to reserve a spot, the service manager will contact me and discuss further details. *

Yes

Required

Send me a copy of my responses.

Submit

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