LAUNCH Summer Program 2024 Registration
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Email *
Is your child eligible for Extended School Year in their school district? If you're unsure, you can find this information in your child's IEP in a box with the following heading: 12 Month Service and/or Program - Student is eligible to receive special education services and/or program in July and August.  *
Our program runs from 9am - 12pm, Monday - Thursday during July and August. Please choose one or both sessions.  *
Required
Student's Name (Last name, first name) *
OPWDD TABS ID# *
Do you have a self directing budget with OPWDD? (If yes, please complete the next section.)
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If you answered yes to having a self directing budget, please provide the name and contact information of your broker and fiscal intermediary. 
Date of Birth *
MM
/
DD
/
YYYY
Address, City, State, Zip *
If applicable, please identify your child's preferred pronouns. 
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Student's email address
Parent name *
Parent address (leave blank if same as above)
Parent email address (if different from above)
Parent phone number *
Emergency Contact Name and Cell Number *
Tell us about your child. What are some important things for us to know about how your child is successful in a group setting? *
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