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Staff
- Staff
- Summer 2025 Staff
Services
Enrollments
Events
Courses
Farm Calendar
Contact Us
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2026 Summer Enrollment 2nd-5th Grade ESA+

THIS ENROLLMENT IS ONLY FOR CURRENT ESA+ GRANT RECIPIENTS.

IF THIS DOES NOT APPLY TO YOU, PLEASE CLICK THE BACK ARROW TO THE HOME PAGE AND CLICK YOUR AGE GROUPS ENROLLMENT BUTTON.

Please make sure you have read Is this a good fit before enrolling

Welcome to Enrollment! Are you a: *

Returning Camper
First time Camper

Child's Name *

First

Last

Date of Birth *

Child Resides with: *

Parent(s)
Guardian
Grandparent
Other

Child's Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

T-Shirt Size *

Child S
Child M
Child L
Adult S
Adult M
Adult L
Adult XL
Adult XXL

Age *

Grade Completed *

Current School *

Parent/Guardian #1 *

First

Last

Parent/Guardian #1 Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #1 Email *

Parent/Guardian #1 Cell Number *

Parent/Guardian #1 Work Number

Parent/Guardian #2

First

Last

Parent/Guardian #2 Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Parent/Guardian #2 Email

Parent/Guardian #2 Cell Number

Parent/Guardian #2 Work Number

Emergency Contact (Other than Parent) Name *

First

Last

Emergency Contact Phone Number *

Emergency Contact Relationship to Child *

How Did You Hear About Us/Referred By? *

Current Client
Former Client
Facebook
Instagram
Website
Family/Friend*
Provider*
Event*
Training*
School*
Other*

Please Elaborate on Your Above Selection if it is Followed by an Asterisk

Current BC Family Member that Referred Me (NA if not applicable)

Others We Know Coming to Camp:

Does Your Child Have an Identified Diagnosis/Delay(s)? *

Yes
No

This also includes any medical diagnoses, such as genetic disorders, chronic conditions such as Chron’s disease, diabetes…..as well as Autism/ADHD/Anxiety, etc.

If Yes, Please List

Is your child currently taking any daily medication? *

Yes
No

If yes, please list medication dosage, frequency, and reason for taking.

Does Your Child Currently Have an IEP/504 plan? *

Yes
No

If Yes, What Level of Support Does He/She Require at School?

Resource (in General Education mostly, with some pull-out and push in supports)
Separate Setting (in a specially designed classroom such as EBS, CCK, etc)

Please answer honestly to the questions below that indicate what type of support your child requires for each area of development! Please note that children that require a HIGH level of support may not be a good fit for our camps.

Language Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Gross Motor Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Emotional Regulation Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Social Engagement

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Transition Support

Minimum Support
Moderate Support

Minimum Support: As needed adult verbal/visual cuing or models, reminders, and some structure to be successful in all environments Moderate Support: Requires adults to provide visuals/verbal cuing or models, reminders and structure

Does Your Child Have Sensory Difference? *

Yes
No

If yes, Please Explain your Child's Sensory Needs

Providers We Are Currently Working With

If We Have Questions or Need More Information for Planning Purposes, Do We Have Your Permission to Reach Out to any of these Providers? *

Yes
No

Please Provide Contact Information for Your Provider (Email/Phone etc)

Does Your Child Have Allergies? (Food/Environmental) *

Yes
No

If Yes, Please Describe or Exchange Their Reaction

Will Your Child Require Medicine at Camp? *

Yes
No

Will Your Child be Bringing Medication to Take as an Emergency for these Allergies, such a an EpiPen? *

Yes
No

Please List Medication:

In case of emergencies where a rash and/or hives and swelling /shallow or shortness of breath are present after exposure to allergen (ex: hay/animal/bee sting), we will contact 911 immediately and then call parent and/or emergency contact. *

By checking this box , I am aware of this protocol by Building Connections, LLC.

Will Your Child Require Medication be given at Camp? *

Yes
No

If Yes, Please List Medication Name, Dosage, Reason for Taking and When/How to Administer.

Please note: you will need to bring it in its original container with specific instructions on administration, dosage, and times of day to be given. This can also be Benadryl used for emergencies when exposed to allergen.

Food Sensitivities/Dietary Restrictions/Foods my Child can not be Offered (if none, say none): *

Toileting *

Independent
Some Assistance
Requires Adult Assistance
My Child is Still in Pull Ups

My Child has had Exposure to Animals, Particularly Farm Animals *

Yes
No

My Child has some Fears About Animals *

Yes
No

If Yes, Please Explain

We do not force engagement with animals; however, we do encourage children to find a way to have safety awareness of animals and be in a comfortable and safe proximity of them with an adult in their own time!

My child has the following fears regarding the outdoors(ex: bugs, heat, etc): If none, say none. *

My Child’s Interests/Likes: *

My Child Does Not Like or Has Fears of: *

My Child is Comforted by or Things that Make their Brain/Body Feel Better/ “Reset” *

Supports that Maybe Helpful for my Child: *

Triggers For my Child and Behaviors Associated with Them: *

Things that are not helpful strategies for my child and their response: For example, my child doesn’t like to take deep breaths, they will escalate and get louder.

Behaviors Noted at Home/School: *

What Goals Do You Have for Camp? *

Do you plan for your child to take part in our BEFORE CARE program (7:30am-9am)? Cost is $20/per day *

Yes
No

If yes, how many days do you estimate you would need this service?

1 Days
2 Days
3 Days
4 Days
5 Days

Please note that we will reach out to you at least 2 weeks before your child’s camp to finalize this decision so that we can prepare for adequate staffing! Thank you! Payment will be due the Monday of camp.

Do you plan for your child to take part in our AFTER CARE program (3pm-5pm)? $25/per day *

Yes
No

If yes, how many days do you estimate you would need this service?

1 Days
2 Days
3 Days
4 Days
5 Days

Please note that we will reach out to you at least 2 weeks before your child’s camp to finalize this decision so that we can prepare for adequate staffing! Thank you! Payment will be due the Monday of camp.

Any other information you feel is important for staff to know?

2026 Summer Camp Selections *

2nd-5th Grade | June 15th - June 19th
2nd-5th Grade | June 22nd - June 26th
2nd-5th Grade | July 6th - July 10th *WAIT LIST FOR 4th & 5th Grades*
2nd-5th Grade | July 13th - July 17th
2nd-5th Grade | July 27th - July 31st
2nd-5th Grade | August 3rd - August 7th

Waiver & Photo Release Completed *

My child is currently/or has been enrolled in BC social skill groups for the 2025/2026 school year and I have already filled out the waiver and photo release.
I need to fill out the waiver and photo release. (link to do so)

Click here to complete the Liability forms

I have read the Summer programming information on the website and by signing here, I am acknowledging that I am making an informed decision about my child’s Summer programming through Building Connections, LLC . I understand that my deposit is non-refundable/non-transferable as well as any payments made towards Summer programming. I understand that I will be invoiced for the remainder of the balance and if I choose can to make payments or to pay in full *

Clear Signature

By signing below I agree that I understand that I will be emailed an invoice from Building Connections for the full amount of the checked camps above April 1, 2026. Once received,I will submit to ESA within 2 days and ClassWallet will pay in full after submitting. If BC does not receive funds from Classwallet within 3 weeks of submitting the invoice, I am responsible for all of the deposits plus a $150 administrative fee. Building Connections is trusting that by not submitting payment today for summer enrollment, that I am doing my part by submitting the invoice promptly April 1, 2026. *

Clear Signature

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© 2024 Building Connections. All rights reserved.

Email our office manager for questions: Kidsconnect.bc@gmail.com

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596

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© 2024 Building Connections. All rights reserved.

Email our office manager for questions: Kidsconnect.bc@gmail.com

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596