BST Summer Camp Application
Thank you for your interest Blue Stars Therapy's Summer Camp. This camp is designed to provide a neurodiverse environment focused on enhancing social & communication skills within a typical preschool routine. This is an excellent way to keep structure from the school year while deepening your child's social and communication skills beyond their classroom and within the community. 

Please fill out each question and submit. This is an application, not an enrollment form. This form expresses interest only. Blue Stars therapy will determine if your child is a fit for our program upon reviewing the information provided. A follow up call or screener with your child may be required. If accepted, you will be contacted via email with the cost breakdown and next steps to secure your child's spot based on your selections. 

Early enrollment for previous/current families closes on February 28th, 2025.
Open enrollment for new families begins on March 3rd, 2025.
Enrollment will close by April 30th, 2025 or when program fills. 

Sign in to Google to save your progress. Learn more
Email *
Today's Date: *
MM
/
DD
/
YYYY
Parent/Guardian Name: (first and last) *
Contact phone number *
Child Name: (first and last) *
Child DOB: (must be 6 or younger AND pre-kindergarten transition) *
MM
/
DD
/
YYYY
Where does your child currently attend school/daycare? *
What grade are they going into next year in? (2025-2026)? *
What type of classroom environment is your child currently in? *
Does your child child have a IEP or formal autism or other diagnosis? *
If yes, please explain/list all diagnoses.
Does your child currently receive therapy services? *
If yes, please list the company, location, and weekly frequency for each discipline (for example: 1 hour/week OT and 6 hours ABA  in home with Blue Stars Therapy) *
Is your child potty trained? (Not a requirement) *
What is your child's primary method of communicating? *
Please indicate any medical, dietary, behavioral , sensory, motor or other concerns for your child at this time. *
Anything else that would be helpful for us to know about your child?  *
Which session(s) are you interested in enrolling in? (Please note we must reach enrollment minimums or groups will be consolidated). Select all. *
Required
For the sessions you indicated above, please select which days your child can attend. *
Required
Are you interested in Before Care or Lunch Bunch? All are offer daily Monday- Friday. Pending minimum enrollment requires are met, before care is offered 8:30-9am if enrolled in the morning session. Lunch Bunch is offered 12-1pm for all. 
Before Care (830-9am)
Lunch Bunch (12-1pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Questions/Comments for us?
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Blue Stars Therapy, LLC.

Does this form look suspicious? Report

Google Forms