Skip to content

Home
Staff
- Staff
- Summer 2025 Staff
Services
Enrollments
Events
Courses
Farm Calendar
Contact Us
Gallery

Search for...

Search for...

Home
Staff
- Staff
- Summer 2025 Staff
Services
Enrollments
Events
Courses
Farm Calendar
Contact Us
Gallery

2026 Summer Enrollment 6th to 12th Grade

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.

We will be going on a field trip off BC campus at least one time during the week. I give Building Connections permission to transport my child to and from the designated location for the field trip. I understand that I will be notified prior to my child starting camp of the details of the trip. I understand that a licensed, experienced adult driver will be driving the vehicle. By checking this box you are giving permission to transport. *

Confirmation I agree to the statement above

My Teen has a Phone/Apple Watch/ or Comparable *

Yes
No

My Teen has Good Phone Habits and is Responsible when Managing It *

Yes
No
N/A

If yes, Please Explain

Does your Teen use their Phone to Listen to Music as a Calming Strategy with Headphones *

Yes
No
N/A

During camp, we like to have teens place their phones in a central location where they can use for a time period after eating lunch. If this will cause issues, we ask parents to keep the phones at home. If there is an emergency or need to contact you, we will do that!

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

2026 Summer Camp Selections *

6th-12th Grade | July 20th - 24th *WAIT LIST*
6th-12th Grade | August 10th - 14th *WAIT LIST MIDDLE*

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

IMPORTANT!! Before submitting your payment please make sure you selected the correct number of weeks of camp you are signing up for in the drop down box below

Enrollment Deposit - Select How Many Weeks in the Drop Down on the Right of Camp You Chose Above - Each Week is a $200 Deposit *

Price: $200.00

Deposit is non-refundable.

Stripe Credit Card *

Facebook

Instagram

Follow us on Social Media

© 2024 Building Connections. All rights reserved.

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

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596

Facebook

Instagram

Follow us on Social Media

© 2024 Building Connections. All rights reserved.

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

Our Address: 7408 Halifax Rd.

Youngsville, NC 27596