Successful Sounds ®

"A Neurologic Music Therapy Based Approach to Teaching the Autistic Child"

Welcome!

Got Music?

Neurologic/Music Therapy

Clinical Sessions

Social Skills Groups

Intro to Camp 2010

2010 Camp Themes

Pricing & Registration

Camper Application Form

Workshops

Location

About Us

Contact
Registration PART I:  Apply
This is not a clinical setting, therefore, camp is not appropriate for children that require physical support or restraint and/or exhibit intensive behavioral or functional needs. For significant challenges and/or for children under the age of 4, clinical sessions are recommended and available summer 2010, Monday-Thursday after 1:00 p.m. 

Requirements:
Must be between the ages of 4 & 10
Must exhibit verbal communication
Must be potty trained/accident free (pull-ups not allowed)
Must be physically healthy (no life threatening health conditions, seizures or heart problems)

“Camp Kidz Rock!”

2010 Camper Application Form
Space is limited so don't delay...

  
How did you hear about "Camp Kidz Rock!"?
Today's Date
Child's First Name
Child's Last Name
Child's Gender
Child's Age
Child's Date of Birth
Child's Diagnosis
Father/Guardian First Name
Father/Guardian Last Name
Mother/Guardian First Name
Mother/Guardian Last Name
Address Line 1
Address Line 2
City
State
Zip Code
Home Phone() -
Father Cell() -
Mother Cell() -
Father E-mail Address (required)
Mother E-mail Address (required)
Why are you interested in "Camp Kidz Rock!"? (20 spaces)
Briefly tell us about your child, including strengths/weaknesses, likes/dislikes. (20 spaces)
What do you wish your child to achieve from this camp? (20 spaces)
Anything else you'd like for us to know?
Which sessions are you interested in your child attending? (Session I; Session II; Session III; Session IV; all)

 After we receive and review your application we'll contact you to schedule your family interview.  Thank you!  
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