2022 ARC Camp Connect Registration Form

Summer Programs

2022 ARC Camp Connect Registration Form

This camp is designed for teens on the spectrum (ages 13-18) that will be able to participate successfully with a 1:3 staff to participant ratio and have a functional form of communication. The cost for the camp is $600 for a 2-week session, plus $30 for an ARC membership. Each day teens will learn social skills, participate in improv exercises, and engage in activities based around the themes for the weeks they have signed up for.

2022 ARC Camp Connect Registration Form

Participant Information

First Name: *

Last Name: *

Date of Birth: *

Diagnosis: *

Ethnic Background: (must choose one from below) *

Allergy: *

Reaction:

Hospitalization #: *

Physician's Name: *

Physician's Phone Number:

School Name: *

Teacher: *

Name of Child & Youth Clinician:

End Section

Would you like to add another participant? *

Yes

Second Participant Information

First Name: *

Last Name: *

Date of Birth: *

Ethnic Background: (must choose one from below) *

Allergies: *

Reaction:

Hospitalization #: *

Physician's Name: *

Physician's Phone Number:

School Name: *

Teacher: *

Name of Child & Youth Clinician:

End Section

Parent / Guardian Information

First Name: *

Last Name: *

Phone number - Cell: *

Phone number – Work:

Phone number – Home:

Email: *

Home Address: *

Please ensure you can be reached during the day on at least one of the above numbers.

Section Buttons

Additional Parent / Guardian Information

First Name:

Last Name:

Phone number - Cell:

Phone number – Work:

Phone number – Home:

Email:

Home Address:

Please ensure you can be reached during the day on at least one of the above numbers.

End Section

Emergency Information

Emergency Contact: *

Phone number - best reached at: *

Relationship to Participant: *

End Section

Method of Transportation *(must choose one from below)

Method of Transportation: *

Parent/Relative pick-up/drop-off

Paratransit

Taxi

Regina Transit

End Section

Preferred Program Session

Please select one only *

Session 1: Sports | Social Justice Monday, July 11- Friday, July 22

Session 2: Nature | Performing Arts Monday, July 25 - Friday, August 5 (no program on Aug 1)

Session 3: Visual Arts | Healthy Living Monday, August 8 - Friday, August 19

If your preferred session is full, are you available for the other session? *

Yes

If yes, select all sessions you are available and willing to register for: (must choose 0-2 options) *

Session 1: Sports | Social Justice Monday, July 11- Friday, July 22

Session 2: Nature | Performing Arts Monday, July 25 - Friday, August 5 (no program on Aug )

Session 3: Visual Arts | Healthy Living Monday, August 8 - Friday, August 19

If additional sessions are available, I would like the opportunity to register for more than one session: * *

Yes

How do you plan to pay for Summer Program? (must choose one from below) *

Terms and Conditions

I agree and accept the below terms and conditions: - All fees, or an agreed upon payment plan, are due prior to June 24, 2022.
Participants who cancel their registration 14 days or more from the start of the program will receive a full refund. If less than 14 days' notice is given, a 50% refund will be issued.
In the event that the Autism Resource Centre needs to cancel a program, registration fee refunds will be provided on a pro-rated basis.
Any supply or material fees for the program will not be included in the refund registrations submitted between 10-10:30 AM on April 23rd will be placed in a random queue for weeks.
Registrations received after 10:30 will be reviewed in order of submission.
Program dates will be confirmed at your final registration meeting. Program waivers and forms must be submitted at time of payment/before the program start date.
Transportation for all participants to/from the camp must be arranged by the family/caregivers.
I give the Autism Resource Centre permission to contact CDS regarding the 2022 Summer Program. Information exchanged will be limited to eligibility for funding.

I agree and accept the above terms and conditions: *

I agree

End Section

reCAPTCHA