Once Upon A Camp 2020… | Center for LifeSkills

Once Upon a Camp is designed for children ages 3-5, with or without a diagnosis, who have basic communication skills, and will benefit from language enrichment and sensory-rich activities.

Participants should be able to manage in a group setting without assistance.

Children will enjoy movement, music, and language activities, arts and crafts projects and a snack.

We will focus on the following skills:

Turn Taking Vocabulary

Social Skills Following Directions

Fine Motor Skills Sensory Experiences

REGISTRATION

Permission to attend*
I give permission for my child to participate in Once Upon a Camp, and all activities associated with it
- Yes
- No
Today’s date
Date Format: MM slash DD slash YYYY
Child’s name*
Date of birth*
Date Format: MM slash DD slash YYYY
Age*
Parents' names*
Social Security Number of one parent:*
Address*
City*
ZIP code*
Email address*
Parent/guardian phone number*
Parent/guardian additional phone number*
Name by which your child is called*
I was referred by:
Allergies
Does your child have a specific medical or educational diagnosis? Please list.
Does your child currently have an IEP?
Does your child attend speech or occupational therapy outside of school?
Please tell us a little bit about your child (likes/dislikes, strengths/weaknesses)
Bathroom policy*
I give permission for the therapists or camp volunteers to accompany my child to the bathroom, if necessary.
- Yes
- No
Media release*
I give permission for my child to participate in photos and videos taken during camp for media purposes for The Center for LifeSkills/Stefanie Peck. My child’s first name, photo and/or videos may be used and seen in printed marketing materials, website content, and/or our Facebook business page. Media will not be shared with any third parties, or appear on any personal Facebook pages. This release will remain active until I or my child's guardian notifies The Center for LifeSkills/Stefanie Peck.
- Yes
- No
Once Upon a Camp costs $415 per child. Once you submit your registration form, you will be contacted by our office for payment. Thank you!
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Phone
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