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Midwest 2026 Summer Day Camp
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Midwest 2026 Summer Day Camp Interest Survey
Thank you for your interest in the Midwest 2026 Summer Day Camp. Please complete interest survey and then visit us at
2115 Garland Avenue
to sign release forms and complete the registration process.
Student's Name
*
Personal Information
*
Date of Birth
Grade Level 2026/2027 School Year
Male or Female
Total:
0
/
0
Parent/Guardian Name(s) and Phone Number
*
Parent/Guardian Email address
*
In order to better serve your child, please indicate if they have been diagnosed with any of the following. Some conditions may require additional information to complete registration.
*
None
ADD/ADHD
Autism
Cerebral Palsy
Rett Syndrome
Asthma, Severe Allergies
Convulsions
Asperbergs
Bipolar Disorder
Down Syndrome
Diabetes
Bleeding/Clotting Disorder
Fragile X
Tourettes
Chronic Health Problems
Heart Defect/Disease
Other
List any medications that your child will take while at the Summer Day Camp
Does your child have an IEP or 504 Plan?
*
Yes
No
Submit
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