Franklin Summer Camp Registration

Franklin Educational Services

Summer Camp Registration

Register your child for our 1:1 supportive summer camp and help us ensure a safe, successful experience for every camper.
Student Information
Student Legal Name*

First NameLast Name
Preferred Name (Optional)
Date of Birth*

MonthDayYear
Age*
Gender*
Preferred Pronouns (Optional)
Current School*
Upcoming Grade (Fall 2026)*
Parent / Guardian Information
Name*

First NameLast Name
Relationship*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency ContactBilling Contact
YesNo
Additional Contact Name

First NameLast Name
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency ContactBilling Contact

Funding Information
YesNo
Funding Source / Agency
Financial Mangement Service
Service Code (if applicable)
Service Coordinator

First NameLast Name
Email
example@example.com

Parent / Guardian Attestation

Please initial each line to confirm your understanding and agreement.
I attest that the information above is accurate to the best of my knowledge. Initial
I understand camp is 1:1, but it must remain safe for my child and our staff. Initial
I understand camp requires independent toileting (no wiping/diapering/changing assistance).Initial
I understand the camp may request early pickup if safety cannot be maintained despite supports.Initial
I understand that children with high-risk bolting/elopement, severe aggression causing injury, or severe self-injury may not be appropriate for this setting even with 1:1 staffing. Initial
Parent / Guardian:   First Name   Last Name
Signature*
Date Signed

MonthDayYear
Date
Should be Empty: