2021 Building Connections Spring & Summer Camp Registration

Child's Information

Child's Name*

Date of Birth*

Grade Completed*

School*

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Parent 1 Information

Parent 1 Name*

Parent 1 Email*

Parent 1 Cell Number*

Parent 1 Work Number

Parent 1 Address*

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Parent 2 Information

Parent 2 Name

Parent 2 Email

Parent 2 Cell Number

Parent 2 Work Number

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Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone Number*

Relationship to Child*

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Camp Information

This year, Building Connections is offering a spring break camp, as well as a summer farm camp and several weeks of summer camps at our Cary office. You are welcome to enroll your child in one or multiple camps, which you can select below.

Spring Break Horse Camp at Excel Kids Farm

Spring Break camp March 29-April 2

$395 per camper / Half day 9am – 1pm
Located at Excel Kids Farm at 6220 Standing Oak Ln, Raleigh, NC 27603

Summer Horse Camp at Excel Kids Farm

Summer Horse Camp June 21-25

$575 per camper / Full Day (see schedule for details based on kids' ages)
Located at Excel Kids Farm at 6220 Standing Oak Ln, Raleigh, NC 27603

Summer Camps Attending at Cary Location

July 5-9

July 12-16

July 19-23

Pre-K/K/1st Grade $395 per camper / Half day 9am – 1pm
2nd - 5th Grade $300 per camper / Half day 2pm - 5pm
Located at the Cary office, 903 Kildaire Farm Rd, Cary, NC 27511

Friends we know coming to camp

The following people have permission to pick my child up from Camp:

Name

Relationship

Name

Relationship

Name

Relationship

Name

Relationship

** You will be given 2 tags to hang on your car mirror for carpool stating your child’s name and teacher – IDs will be checked for people picking up other than parents **

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Child's Medical Information

Allergies*

Medication taken daily/side effects*

Does your child need medicine administered while at camp?*

Yes

If so, please include a doctor's note. A nurse will be available on an as-needed basis.

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Child's Behavioral Information

My child likes:*

My child is comforted by:

My child dislikes:*

My child needs support with:

Social behaviors (personal space/greetings/goodbyes)

Conversational skills

Making/keeping friends and getting along (social rules/initiating/problem solving)

Emotional Regulation (labeling emotions/understanding emotions of him/herself and those of others/relaxation techniques during times of frustration or times of stress)

Supports that may be helpful for my child

Visual Schedule

Model/demonstration with verbal directions

Physical supports to transition and navigate environment (objects, person, ride in a wagon for longer periods of walking, etc)

Auditory cues for transitions

Preferential placement during instruction/activities

Wait time after verbal directions

Sensory Breaks or Brain breaks

Other

Triggers for my child or Behaviors noted at home/school

What goals do you have for camp?

Other information you would like camp staff to know about your child:

Child's Information

Parent 1 Information

Parent 2 Information

Emergency Contact Information

Camp Information

Child's Medical Information

Child's Behavioral Information

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