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
Best way to contact you

Other
Childs Date of Birth

MonthDayYear
Date
My child currently receives the following services :
Where is your child receiving services?
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.
If you are currently in Speech or Occupational therapy at our clinic or another clinic, what days does your child receive these services?
Are you interested in private pay or using insurance for therapy services during camp?

Other
I am interested in my child receiving the following services during summer camp:
What age group are you interested in?
Below are the day/times at the Meridian camp.Please pick the day/time that is preferred. Selected times are not guaranteed and are based on availability. (Please note that if your child currently receives therapy, your camp days will need to be on different days from your current therapy days)
I want my child to attend the following session/s
How does your child communicate?

Other
Diagnoses:

Other
Challenges: Please check the following challenges that describe your child
Our current adult to child ratio is approximately 1:4. Will your child need additional support?
I acknowledge that if my child needs additional support, that I will be able to provide it
Is your child potty trained? If your child is not fully potty trained, a parent of guardian must remain available during camp hours and be able to arrive within 15 minutes if called to assist with toileting needs.Please note: We are not a licensed childcare facility and staff are unable to provide diapering or toileting assistance.
What do you hope to gain from the summer group?

Other
I acknowledge that this is NOT a free service. I understand that my insurance/Medicaid will be billed for services received or that I am agreeing to the private pay option.
I would like to use my Empowering Parent grant
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
Shirt Size
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.

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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!

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. *

Payment Methods

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.