Occupational Therapy Camp

July 22-25, 2019

Intermountain Campus
500 S. Lamborn Street
Helena, MT

Your Name
Camper's Name
Grade in 2019
Camper's Age
Address
City
State
Zip
Phone
Email
Camping Dates
Known Allergies
Medications Currently Taken
Behavior Concerns
Motor Ability or Concerns
Emergency Contact Numbers Mom Daytime:
Mom Cell:
Dad Daytime:
Dad Cell:
Emergency Contact (if parents can't be reached) Name:
Phone:
Relationship:
T-Shirt Size (T-shirt might shrink when washed, so please order one size larger)
Promo Code
* Registration will not be finalized until payment is made on the next screen *