Coquitlam Winter Camp

Child's name

Guardian's name

Child's Birthday

Email*

Phone

Choose you week :

December 23 (Winter Crafts)

December 26 (Winter Baking)

December 27 (Funny Outfit Day)

December 30 (Sensory Day)

December 31 (New Year Celebration)

January 2 (Winter Baking)

January 3 (Winter Crafts)

How does your child communicate?

Speaking

Non-Speaking

Visuals

AAC

Gestures

Do you need Individual Support? (additional $25/h)

Yes

No

Please list any triggers

Please describe de-escalation procedure

How would you like to pay?

AFU

E-transfer/credit

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