Intake form

Name *

Email address *

What is your child's age?

What are the primary academic skills your child needs support with?

Please select at least one option.

Reading

Writing

Mathematics

Science

Social Studies

What social skills would you like your child to develop?

Please select at least one option.

Communication

Teamwork

Conflict Resolution

Empathy

Self-Regulation

What is your preferred method of communication?

What are your availability preferences for camp sessions?

Please select at least one option.

Week 1

Week 2

Week 3

Week 4

Week 5

Week 6

Week 7

Week 8

Please specify any specific academic goals for your child during the camp.

Do you have any concerns regarding your child's learning style or needs?

How did you hear about summerset center of achievement?

Additional questions or comments

Summerset Center of Achievement