Kids Connection Application 2024
Every new family needs to complete this form. 
Once this is completed, you will be contacted to set up a Zoom interview. 
After the Zoom interview you will be contacted regarding your acceptance into the program. 
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Date of completed form *
Child's name (first and last) *
Parent's/Guardian's name (first and last) *
Date of birth *
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Age of child *
Siblings name and ages *
Primary contact phone number *
Primary contact email *
Primary address *
School attending *
Public school district *
Grade entering in September 2024 *
Is your child currently in a social skills program? *
Has your family worked with a behaviorist within the last three years? *
Does you child currently have an IEP? *
Does your child currently have a 504 plan? *
Does your child currently have a one to one aide?    Kids Connection does not accept students who require a one to one for our large group camp. However, during the interview we may offer our Kids Prep small group program. *
Which sessions are you interested in? *
Required
How did you hear about Kids Connection? *
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