HIA Summer Camp Registration

Program Registration

Participant Information

Name*

First Middle Last

Date of Birth (dd/mm/yyyy)*

Age

(calculated automatically)

Parent Information

Parent/ Guardian Name*

First Last

Email*

Postal Code*

Phone*

How did you hear about HIA Summer Camps?*

FSCD/PDD
Word of Mouth
Online Search
Social Media
Other

Please explain

Funding Confirmation

Families are required to contact their caseworker to ensure billable hours/services towards summer camp.

I have contacted my caseworker about billable hours/services towards summer camps.
My contract already contains billable hours/services towards summer camps.
I do not have a funding agreement. I agree to pay all costs out-of-pocket.

Funding Agency*

ID #

Contract Expiry

Agency Worker*

Enter your worker's name

Worker's Email*

Worker's Phone Number

Camp & Respite Hours

If you require cancellations, please contact our team. Before and after care are available for an additional fee. If you are adding hours to before/ after care, AdaptAbilities makes every effort to accommodate. We require a minimum 14 days notice prior to changing hours to requested care.

Camp & Respite Hours

Before & After Care*

Before Care (7:30 AM - 9:00 AM)
After Care (3:00 PM - 6:00 PM)

Drop Off Time*

:

Please enter your desired drop off time.

Pick Up Time*

:

Please enter your desired pick up time

T-Shirt

T-shirts are for participants to keep and wear during camp. Order includes one free T-shirt. Additional T-shirts can be purchased for $20. Please select the appropriate sized T-shirt for participant.

Size*

AdaptAbilities HIA Summer Camp Registration Form

2025 HIA Summer Program Registration

Step 1 of 6

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