Over The Moon Summer Camp Registration
Please Fill out this form to Register for our therapist facilitated and designed Summer Handwriting/Motor Skills Camp 2024. Summer camp runs Monday-Thursday 9:00 AM-4:00 PM. Wrap around care is available 8:30-9:00 AM and 4:00-5:00 PM for an additional fee.  Camp Cost is $750 per week, $1500 per session. Full payment is due by May 15th. After we receive this we will call you to set up payment and confirm your placement at camp! We look forward to having so much fun with your child this summer!
Email *
Which Session of Camp (2 week sessions) do you want to register for *
Required
How many days of camp will you need wrap around care? Cost is $20 per day. $1.00 per minute will be charged for pick up after 5:00 PM *
Child's Name (First and Last) *
Child's Gender *
Preferred Pronouns *
Child's Date of Birth *
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Child's Grade in Fall of 2024 *
Child's Address *
Parent 1 Name  (First and Last) *
Parent 1 Contact Phone Number *
Parent 1  email address *
Parent 2 Name  (First and Last)
Parent 2  email address
Parent 2 Contact Phone Number *
Additional Parent/Caregiver Information. If your child has additional parents who will be picking up or dropping off at camp please list their name, relationship, and phone number.  *
Additional Emergency Contact. Please list at least one additional contact Person not listed above who we can contact in case none of the above adults are reachable in the event of an emergency or illness.  *
Additional Emergency Contact Phone number. *
Allergies. Please list ANY known allergies to Food, Medication, or the Environment.  *
Dietary Restrictions. Campers are required to bring a packed  cold lunch and two snacks for camp (a refrigerator is available). As well as a water bottle. However there may be special days or projects that involve camp provided snacks or drinks. Are there any foods that your child may not or cannot eat while with us at camp? *
Tell Us more about your child and what you are hoping they will get out of our summer camp program. *
Let us know what concerns you currently have about their handwriting. How do they feel about writing? Can you and others read their writing? Can they read their own writing? 
 *
Does your child have an IEP or other support services at school? Do they have a medical, educational, or psychological diagnosis?
 *
Is there anything else we should know about your child to help them have a great time at camp? This can include strategies you use to help them when they have a hard time, things they really love, sensory experiences they have a hard time with, themes or characters they really enjoy etc. Give us as much information as you can! *
Is your child able to use the bathroom on their own? Are they consistent in asking to go or going in less familiar places? *
Has your child had school or camp experience in the past? How do they typically do when they are away from you? Do they have a hard time with separation when you leave? If so what has helped them in the past?? *
A copy of your responses will be emailed to .
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