Build Your Skills Summer Camp Registration

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Thank you for your interest in Kidable's summer camp! Kidable's groups are hosted by pediatric occupational therapy professionals to enhance functional skills in a fun environment. For optimal individualized attention, these groups are kept small.

Completion of this form does not guarantee registration. Registration is complete once payment is received. The registration payment is non-refundable. Registration Payment Link

Please complete a new form and payment for each child participating.

Email *

I confirm I am registering my child for Kidable's Build Your Skills Summer Camp, which costs $195 (usually $215) and is hosted at our *new* location in Cave spring. Our address is 4335 Brambleton Ave. This camp runs from Monday, July 31st to Thursday, August 3rd, 2023. *

Yes and I have paid using the link above

Yes and I plan to pay after completing form

Required

Full Name of Participant *

Participant's Age *

Participant's Birthday *

YYYY

Participant's Preferred Pronouns *

he/him

she/her

they/them

Other:

Home Address (Street, City, State, Zip) *

Name of Caregiver (1) *

Phone Number for Caregiver (1) *

Email for Caregiver (1) *

Name of Caregiver (2)

Phone Number for Caregiver (2)

Email for Caregiver (2)

Name of Emergency Contact (if caregiver(s) cannot be reached) *

Phone Number for Emergency Contact *

Emergency Contact's Relationship to Participant *

Grandparent

Aunt/Uncle

Family Friend

Babysitter

Other:

Required

Please list the names and phone numbers of anyone approved to pick up or drop off the child to the group. *

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