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Camp CAS 2024 - Summer Camp Intake Form
Thank you for your interest in our Camp CAS Summer Camp. Please fill out this intake form to provide us with information about your child. If you have more than 1 child, please complete 1 form per child.
To complete registration, you will be contacted by SLLC to review and gather information about your child to determine their fit for the program. Should programming be a match for your child a $100 non-refundable deposit will be required to secure a spot in camp.
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* Indicates required question
Child's Name & Birthdate
*
Your answer
Parent Name
*
Your answer
Parent Contact: email & phone number
*
Your answer
Please select the camp you're interested in:
*
Preschool, Age 3-4 years - July 29 - Aug 2, 2024 (half day camp, 9:00am-12:00pm) (CAMP IS FULL, please select to be added to our camp waitlist)
Kinder-Grade 1, Age 5-6 years - July 15 - 19, 2024 (half day camp, 1:00pm-4:00pm) (1 spot left)
School Age, Grade 2+, Age 7-11 - August 12-16, 2024 (half day camp, 9:00am-12:00pm) - CAMP IS FULL, please select to be added to our camp waitlist
Required
Prerequisite Skills
*
Respond to their name
Attend to a task for 5 minutes+
Use the bathroom independently
Follow simple directions
Understand & participate in turn-taking
My child can:
Respond to their name
Attend to a task for 5 minutes+
Use the bathroom independently
Follow simple directions
Understand & participate in turn-taking
My child can:
Additional Information
*
Diagnosed with Childhood Apraxia of Speech
Suspected to have Childhood Apraxia of Speech
Diagnosed with a speech-motor learning disorder
Suspected to have a speech-motor learning disorder
Diagnosed with or suspected to have Dysarthria
My child is:
Diagnosed with Childhood Apraxia of Speech
Suspected to have Childhood Apraxia of Speech
Diagnosed with a speech-motor learning disorder
Suspected to have a speech-motor learning disorder
Diagnosed with or suspected to have Dysarthria
My child is:
Any additional information you would like to share about your child:
*
Your answer
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