DSAMT Friendship Camp Registration - July

This unique camp is specifically designed for children with Down syndrome and is directed by two highly-qualified behavior analysts who work with children with disabilities, including Down syndrome.

Children will benefit from small group instruction with one of two behavior analysts, while learning alongside age-appropriate peers. The cost is $100 per child with Down syndrome, and siblings & typically-developing friends cost $50. Space is limited and the camp will fill up. One registration for each camper must be completed.

Once you complete this online form, you will receive an email with the release forms and questionnaire about your child.

The registration below will reserve your spot in the July 21-25, 2014 for those age 5-7. However, ALL paperwork and fees must be received in order for the registration to be considered complete. All paperwork and fees MUST be received by July 12, 2014, so that the behaviorists can make any needed adjustments to their plans for camp.

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1. Please tell us about the camper:

Name:

Address:

City/Town:

State:

ZIP:

Age:

Email Address:

Phone Number:

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2. Does this person have Down syndrome or are they a sibling?

Has Down syndrome

Is a sibling

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3. Please describe any special considerations or concerns that may be helpful to our staff and volunteers (e.g. behavioral, medical, elopement, allergies, etc.):

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4. Please provide an emergency contact and information.

Name: *

Relation to Guest: *

Email Address:

Best Phone Number: