Kids Connection Apply

Apply Now for 2021
Registration opens
February 1, 2021

Complete this form to learn more about our SUMMER SESSIONS.

* 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? *

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