Kids Connection Apply

Apply for Camp Now
As of May 18th
registration is still open
You must complete for virtual programs also.

Complete this form to learn more about our SUMMER CAMP AND VIRTUAL PROGRAMS.

* Indicates required field

Your First Name *

Your Last Name *

Your Email *

Your Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Camper Name(s) *

Date(s) of Birth *

School Attending *

Public School District *

Grade(s) Entering in Sept 2019 *

Does your child have an IEP? *

Yes No

Does your child have a one-to-one aide? *

Yes No

How did you hear about our camp? *

Online Search Website Referred by family/friend School Referred by a professional Church bulletin Local Patch Article Facebook Other

Any other comments or questions? *

Submit