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

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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

Parent's Name(Required)

First Last

Home Phone(Required)

Cell Phone(Required)

Work Phone

Email(Required)

Parent's Name(Required)

First Last

Home Phone(Required)

Cell Phone(Required)

Work Phone(Required)

Email(Required)

Marital Status

Who 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)

If other please list name:

First Last

Phone

Children/ Youth ages 17 & under will not be authorized to leave on their own without prior written parental consent:(Required)

Has your child been formally diagnosed with a Learning Disability?(Required)

Yes

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

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

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 policy

LDATD 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 [email protected]
• Cancellation notice/refund requests must be submitted in writing via email to [email protected].
• 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 Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name