Children: Yearly Camps: March Break Friendship Club: Registration **REGISTRATION CLOSED FOR 2024 Complete the below form to register for LDATD’s 2025 Summer Camp! Step 1 of 4 25% Child's Name(Required) First Last Date of Birth(Required) Month Day Year Month/Date/Year Age(Required)Grade (as of Sept. 2024)School attending in September 2024:Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Parent's Name(Required) First Last Home Phone(Required)Cell Phone(Required)Work PhoneEmail(Required) Parent's Name(Required) First Last Home Phone(Required)Cell Phone(Required)Work Phone(Required)Email(Required) Marital StatusWho does the child reside with?(Required)Who has custody of the child?(Required)Siblings Names and Ages:Emergency Contact(Required) First Last Please list someone other than parents listed above who would be available during program time.Relation to Child(Required)Emergency Contact Number(Required)Who will be picking up and dropping off the child?(Required)Parent 1Parent 2OtherIf other please list name: First Last PhoneChildren/ Youth ages 17 & under will not be authorized to leave on their own without prior written parental consent:(Required)My child/youth has my permission to leave after program on their ownI will be dropping off and picking up my child. Please wait with them until I arrive. Has your child been formally diagnosed with a Learning Disability?(Required) Yes No I don’t know ** Please note that your child does not have to be formally diagnosed to participate in our programs.If yes, type of LD: Phonological Processing Language Visual-Motor Visual- Spatial (Perceptual Skills) Memory Processing Speed Executive Function Other Comments:Does your child have an AD(H)D diagnosis:(Required) Yes No I don’t know If yes, type of Attention Disorder (i.e. Inattentive, Hyperactive)Specify what areas your child struggles with beacuse of their learning disability, even if there is no formal diagnosis (i.e. social skills, reading, writing, math, fine motor skills, typing, ect.):(Required)Has your child been diagnosed with any other exceptionalities (i.e. Autism Spectrum Disorder, Developmental Disability)? Please list any exceptionalities:(Required)Please identify any behavioural challenges & plans that LDATD should be aware of (i.e. aggressive, running away):(Required)How does your child function in a group setting (i.e anxious, comfortable, easily distracted) ?(Required)Is your child taking any medication? If yes, please specify:List any known allergies and severity of allergies. Does your child carry an EpiPen?Any additional information we should know: Is your child on an IEP?(Required) Yes No I don’t know Placement at school:(Required) Regular Class Regular Class Withdrawl Support Special Class Other Comments:Tell us about your child's learning style.(Required)What are some of your child's strengths?(Required)What social difficulties does your child face at school?(Required)What specific goals/ social areas would you like to see worked on in the program?(Required) Establishing Friendships Maintaining Friendships Non-Verbal Communication Active Listening Problem Solving Cooperation & Compromising Approachability & Making Plans Dealing with Bullying Self-Esteem & Confidence Anger/ Emotional Awareness How would you best describe your child’s current keyboarding ability?(Required)What areas would you like to see worked on in the program? Speed Accuracy Posture Finger Placement Please list 1 or 2 specific goals you would like to see addressed in our program.(Required)What accomodations, if any, have successfully helped your child in the classroom?(Required)Additional comments that will assist us while working with your child:Please describe any other areas that you feel your child might need extra support.(Required)I give permission for my child to photogrpahed for organizational purposes.(Required) Yes I give permission No I do not give permission How did you hear about our programs? Please be as specific as possible.(Required) Online Search Online Ads Flyers, pamphlets, ect. LDATD staff Friend External Referral (Doctor, Dentist, Social Worker) Other Please select one Please specify how you heard about our program?(Required) Please select:(Required) North York: July 21-July 25 North York: July 28-August 1 North York: August 5-August 8 (*NO MONDAY CIVIC HOLIDAY*) North York: August 11-August 15 EARLY BIRD SPECIAL: July 21-July 25 EARLY BIRD SPECIAL: July 28-August 1 EARLY BIRD SPECIAL: August 11-August 15 NO PAYMENT Consent to Refund/Cancellation Policy:(Required) I agree to the Refund/Cancellation policyLDATD In- House Programs Refund/Cancellation Policy: • 80% of the program fee will be refunded on cancellations received 10 or more business days prior to the start of the program. Refunds will only be honored on full payments. • 50% of the program fee will be refunded on cancellations received less than 10 business days prior to the program start date. Refunds will only be honored on full payments. • No refunds will be issued on or after the first day of program **Refunds may be considered in exceptional circumstances. Please submit requests via email to programs@ldatd.on.ca • Cancellation notice/refund requests must be submitted in writing via email to programs@ldatd.on.ca. • LDATD reserves the right to cancel a program and will offer a full refund Total Please continue to the next screen to submit your registration. Please note that registration in not complete until a payment has been made. Spots will not be held without payment. The Program Manager will contact you shortly via email to provide you with program details. Please Note: • Due to enrollment requirements, program availability is subject to change Thank you!Payment MethodPayPal Checkout MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name Δ Re-Registration for Online Programs Children: Smart Kidz Tutoring: Registration Children: Assistive Technology: Registration Children: Keyboarding for Kids: Registration Children: Friendship Club: Registration Children: Yearly Camps: Summer Camp 2025 Keyboarding & Friendship Club For Kids: Registration Children: Yoga & Mindfulness: Registration Children: Yearly Camps: Summer Keyboarding For Kids: Registration Children: Yearly Camps: Summer Friendship Club: Registration Children: Yearly Camps: Summer Yoga & Mindfulness: Registration Youth: Befriend: Registration Youth: Y.I.E.L.D (Youths’ Initiative and Excellence with LD’s): Registration Youth: H.I.R.E. (Youth Help in Reaching Employment): Registration Youth: Smart Kidz Tutoring Registration 2021 In-Person Program Waitlist Youth: Y.E.L.P (Youth Empowerment & Leadership Program): Registration Youth: Typing for Teens: Registration Youth: Yoga & Mindfulness: Registration