Crossway Academy
Home
About
About Crossway
2021-2022 Parent Info
Prospective Students
Educational Tutoring
After School Club
News
Calendar
Contact
Pay Now
Middle School
Summer Camp
Camp Registration
Volunteer Application
Crossway Blog
Therapy
Crossway Academy Academic Summer Camp Registration
Week(s) you are registering for:
*
June 28 - July 1
July 5-8
August 2-5
August 9-12
*
Indicates required field
Child's Name
*
First
Last
Date of Birth
*
Age
*
Diagnosis
*
School Name
*
Daytime Phone Number
*
Family Email
*
Type of Placement in school
*
Grade level
*
Describe your child's communication level
*
Does your child have any significant behavior issues? If so, please explain
*
Does your child display age appropriate toileting and feeding skills? If not, please explain
*
Parent/Guardian Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Mother/Guardian Cell Phone Number
*
Father/Guardian Cell Phone Number
*
Date of Last Medical Exam
*
Is your child in good health to participate in outdoor activities?
*
Yes
No
For short periods of time only
Are there any specific physical or emotional restrictions? If so, please explain
*
Allergies
*
Medications
*
Does you child need an Epi Pen or Inhaler? If yes, please send these on the first day
*
Epi Pen
Inhaler
None of the Above
*For Medical Needs, your insurance company is responsible for transportation*
Photos of my child may be used on the Crossway Academy website
*
Yes
No
Please list any friends you would like to receive camp information. Names and email addresses:
*
Parent/Guardian Signature. I certify that all information submitted on this form is true and that I have the authority to register the above child for summer camp.
*
Date
*
Submit
Home
About
About Crossway
2021-2022 Parent Info
Prospective Students
Educational Tutoring
After School Club
News
Calendar
Contact
Pay Now
Middle School
Summer Camp
Camp Registration
Volunteer Application
Crossway Blog
Therapy
