2026 Meridian Summer Camp Registration FORM

2026 Meridian Summer Camp Registration FORM

Please complete this form so you can be added to the list for summer camps!
Summer Camp Payment Options
We offer a few different ways for families to participate in We Are Better Together Summer Camp. We continue to accept insurance for eligible therapy services, along with a $25 non-refundable deposit to hold your child’s spot. Families may also choose one of the private pay options below.

Summer Camp Rates
Camp Only (No Individual Therapy)
This option includes all camp activities and groups.
• $50 per day
• $800 total for the full 8-week session (2 days per week)

Camp + Individual Therapy
30 minute therapy session (either OT or Speech) while attending summer camp.
• $83 per day
• $1,328 total for the full 8-week session (2 days per week)
• Therapy may be Occupational Therapy or Speech Therapy

Need a little extra support?
Scholarships may be available for qualifying families. Please reach out if you’d like more information.
Name of Child*

First NameLast Name
Name of Parent/Guardian*

First NameLast Name
Phone Number of Parent/Guardian*
Please enter a valid phone number.Format: (000) 000-0000.
Email of Parent/Guardian*
example@example.com
EmailPhoneOther
Childs Date of Birth*

MonthDayYear
Date
Speech TherapyOccupational TherapyNot Currently Receiving Services
We Are Better TogetherOtherN/A
If receiving services at another location, what is the name of the clinic/school your child receives services? Please put N/A if your child is not receiving services.*
OT MondayST MondayOT TuesdayST TuesdayOT WednesdayST WednesdayOT ThursdayST ThursdayOT FridayST FridayN/A
Private PayPrivate Pay without therapy servicesI am not interested in private payOther
Speech TherapyOccupational TherapyOnly interested in summer camp through private pay without services
Preschool 3-4Young child 5-7Child 8-10Pre-Teen 10 and up
Monday 9:00am - 11:00amMonday 12:00pm - 2:00pmMonday 2:00pm - 4:00pmTuesday 9:00am - 11:00amTuesday 12:00pm - 2:00pmTuesday 2:00pm - 4:00pmWednesday 9:00am - 11:00amWednesday 12:00pm - 2:00pmWednesday 2:00pm - 4:00pmThursday 9:00am - 11:00amThursday 12:00pm - 2:00pmThursday 2:00pm - 4:00pm
June 1st-June 26thJuly 6th-July 31stBoth
Non verbalGesturesSingle wordsShort phrasesSentencesEngages in conversationsOther
No diagnosisAutism Spectrum DisorderADHDSpeech/Language DelayDown SyndromeCerebral PalsyCognitive Impairment/Developmental DelayOther
AnxiousWithdrawnRigidImpulsiveVerbally aggressivePhysically aggressiveDistracted/distracting to othersOppositional
YesNo
YesN/A
Yes my child is fully potty trainedNo my child is not fully potty trained
Conversational skills (greetings, initiates, eye contact, engaging, staying on topic, interrupting)Making friendsPlay skills (turn taking, initiating, sustained play, following rules, sportsmanship)Practice using or increasing Speech/Language SkillsPractice using or increasing Occupational Therapy Skills (Fine motor, sensory, etc)Other
I acknowledge
YesNoDoes not apply
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any allergies? If no, type "None" in the box below*
Child Size (4)Child (5-6)Child (7-8)Child Size (9-10)Child Size (10-12)Child Size (14-16)Adult SmallAdult MediumAdult LargeAdult X Large
How did you find out about our camp? If it was from one of our staff please write in the staff members name. *
Exciting things are coming your way! Keep an eye on your inbox for an email with all the details on what's next in your summer camp journey!
Camp Registration Fee - There will be a $25.00 registration fee for summer camp this year to cover cost of supplies, shirts, water bottles, etc. This is a nonrefundable fee. Weekly therapy sessions are covered by insurance or Medicaid. Copays/coinsurance will apply. *

prevnext( X )
USDSupply and T Shirt Fee.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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2026 Meridian Summer Camp Registration FORM

Exciting things are coming your way! Keep an eye on your inbox for an email with all the details on what's next in your summer camp journey!