Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Parent Name

First Name

Last Name

Parent Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Full Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Address (if different than above)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

I am submitting this form with all the correct and most accurate information. I understand that my child and/or myself is expected to be compliant with treatment and participate as much as possible in all sessions and activities unless otherwise informed.

Agree

Disagree

I understand that my child's information will be de-identified and possibly used in a study specific to treatment outcomes while at Camp Watchme.

Yes

I have signed the Waiver of Liability/Photo Release (link located at the top of the page.) I understand that failure to pay the registration fee will result in an incomplete registration and my spot will not be guaranteed. *

Yes

I am unable to pay the full registration amount today and would like to request an extended deadline. I understand that full payment will need to be completed by March 1st, 2025. Failure to do so will result in losing our spot at Camp Watchme 2025.

Yes, I would like to pay the $200 non-refundable deposit today and be sent an invoice for the remaining balance.

No, I will pay the full amount to hold my spot