Limited Spots Available

Summer Camp Registration

Register your child for an engaging, enriching summer experience at The Canaan Center. Space is limited — secure your spot today.

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Summer Camp has limited enrollment. Registrations are reviewed on a first-come, first-served basis. Submitting this form does not guarantee a spot.

Step 1

Child Information

Child’s First Name *

Child’s Last Name *

Date of Birth *

Age *

Gender

Grade / School Year

T-Shirt Size

Diagnosis / Disability (if applicable)

Step 2

Parent / Guardian Information

Full Name *

Relationship to Child *

Phone Number *

Email Address *

Best Way to Reach You

Home Address *

Step 3

Enrollment & Funding

Does your child have Medicaid? *

YesNo

Scholarship Needed?

If your family needs financial assistance, we want to help. Selecting “Yes” will not disqualify your child — it simply lets us explore options together.

YesNo

Ready to submit?

By submitting this form, I confirm that the information provided is accurate and that I am the parent or legal guardian of the child listed. I understand that submission does not guarantee enrollment and that a Canaan Center team member will contact me to confirm next steps.

I agree to the above statement and consent to The Canaan Center contacting me regarding this registration. *