Register for Summer Camps / ¡Regístrate ahora para los campamentos de verano!
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English Registration Info
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Summer Camp weeks needed:
Week 1: June 3-June 7
Week 2: June 10-June 15
Week 3: June 17-June 21
Week 4: June 24- June 28
Week 5: July 1- July 5 (Closed July 4th)
Week 6: July 8- July 12
Week 7: July 15- July 19
Week 8: July 22 – July 26
Camp Hours Needed:
Monday-Friday 9 am-3 pm
Before Camp 7:45am-9am ($5 per day)
After Camp 3pm-6pm ($5 per day)
Referred by:
Parent / Guardian Name
*
First
Last
Phone Number
*
Email
*
Are you working or attending school?
*
Yes
No
Family Language
*
Family Yearly Income
*
PLEASE TELL US ABOUT YOUR CHILD
Child's name
*
First
Last
Age
*
Date of Birth - Month / Day / Year
*
City
*
Zip Code
*
County
*
Diagnosis
*
Do you have insurance?
*
Yes
No
If you have insurance, what type?
Transportation needs
Current care
*
Developmental age
*
Is your child walking?
*
Yes
No
Does your child use DME (durable medical equipment)?
Yes
No
Any other info regarding mobility?
Is your child potty trained?
*
Yes
No
Communication Needs
*
Verbal
Non-Verbal
Additional communication info:
Does your child receive:
Physical Therapy (PT)
Speech Therapy (ST)
Occupational Therapy (OT)
Does your child receive feeding therapy?
Yes
No
Does your child receive other therapy? Please describe.
Does your child eat by mouth?
*
Yes
No
Special diets or accommodations?
Does your child hold utensils?
*
Yes
No
Does your child have a G-tube or nasal tube?
*
Yes
No
Does your child have allergies? List here
Please describe medication or treatment needed by your child:
Comments about your child's behavior:
Submit
For help please contact
María Castro
214-765- 5267
mcastro@bryanshouse.org
Register for Summer Camps / ¡Regístrate ahora para los campamentos de verano!
About Us ˅
> Our story
> Events
> Videos
> Success Stories
> Press
> Contact us
Programs & Services ˅
> What We Do
> Beyond Breaking Barriers / Voz Alta
Careers
Get Involved ˅
> Me and My Buddy Fundraiser
> Events
> Volunteer/Jubilee Brigade
> Corporate Engagement
> Development
Support Us ˅
> Me and My Buddy Fundraiser
> Donate Now
> Fundraise
> Wish List
> Events
***FOR BOARD MEMBERS: BOARD PORTAL
