MMM & Speak Out Summer Camp 2022
We're excited to have you at our OT and Speech Therapy Summer Camp, hosted by Mighty Minds and Muscles and Speak Out New York! Please fill out this form to sign up. We will follow up in the coming weeks to confirm dates, process payment, and provide additional details.

Location: 100 Reade St. and local park(s)
Hours: 9:15-2:15 (3 hours lead by OT, 2 hours lead by Speech)
Days: MON-THURS - except holiday weeks
Subject to enrollment. Subject to change.
Price: $1100/week (4 days). Weekly attendance preferred. $275 per day for limited exceptions.
Private therapies sessions completed outside of camp hours for OT, PT, Speech, SETSS, tutoring, etc.

Information listed on this form will be shared with both Mighty Minds and Muscles and Speak Out New York.
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Email *
Child's Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Parent's Name *
Parent's Email *
Parent's Phone Number *
Primary Doctor (Pediatrician)
Primary Doctor's (Pediatrician) Phone Number
School
Grade/Preschool Class Age
Reason for interest in camp? *
Which of these appeal most to you? You may select more than one.
Are you currently enrolled in services with either MMM or SO NY?
Clear selection
Currently receiving therapy elsewhere?
If receiving therapy someplace else, where?
Funding Source
Which dates would you like your child to attend? Current planned dates are July 5th-September 2nd, 2022, but please specify any dates you are interested in. If interested in dates outside of those listed, please specify them in "Other". *
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