Voices together registration form
Please print clearly and complete a separate registration form for each camper.
All campers must submit the All Camps Registration Form and Payment Form along with this registration.
Child’s Name:________________________________________ Birthdate:___________________ Grade (Fall ‘19):________
{
Week 7: July 29 - August 2
Week 8: August 5 - 9
Week 9: August 12-16
{
Grades K-8
9:00 a.m. - 3:30 p.m. r Week 7
r Week 8
r Week 9
T-shirt size: r YS r YL
r YM
r Member r Non-Member
$335 M / $385 NM
$335 M / $385 NM
$335 M / $385 NM
r S
r M
r L
r XL
We are pleased to offer this opportunity. However, there are limited spaces available and in order to accommodate the most campers,
enrollment is limited to two weeks. A fifty percent deposit is required with this registration. The deposit will be refunded if your child is not selected
for Voices Together. If your child is selected the balance must be paid in full by June 1, 2019. Fees may be charged on MasterCard, American Express or Visa
or paid by Electronic Funds Transfer (EFT). There will be no refunds after June 15, 2019.
Peer Camper Application
(no fees apply)
Peer campers must also complete the All Camps Registration Form (page 29)
To be considered for this program, peer campers should be in the 8th grade or higher. When the camp is full, peer camper applicants will
be placed on a waiting list.
Select which weeks you are interested in as a peer camper:
r July 29 - August 2
r August 5 – 9
r August 12 - 16
Please list your experience working with children with Autism:___________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
Please describe your interest in working at Voices Together:_____________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________
Important things to bring to camp: Smile, promptness, flexibility, patience, hearty lunch, bathing suit/towel and lots of energy!
Scan, email, fax or mail your Peer Camper application to:
Melissa Bunce, Weinstein JCC Director of Inclusion and Support Services
5403 Monument Avenue • Richmond, VA 23226 • Phone: (804) 545-8658 • Fax (804) 285-3139 • [email protected]
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