New Camper Intake

Learn More About Our School or Camp

Please fill out the form below if you're interested in our camp or school program. If you’re interested in our therapy clinic, click here.

Hidden Fields

Person Account Record Type ID

Student Account Record Type ID

Parent-Child-CCR Role Relationship ID

Guardian-Child-CCR Role Relationship ID

Case Inquiry Record Type

Parent/Guardian

First Name

Last Name

Phone

Relationship to Child

Child Information

First Name

Middle Name

Last Name

Preferred Name

Name participant goes by

Date of Birth

Gender

Diagnosis

Main Concerns

Strengths

Needs

My child has at least one Jewish parent

YesNo

Jewish Community Affiliation

Current Program or School and Grade

Level of Support in Classroom / Program

Past or Current Therapies

Medical History

Describe your child's level of communication

Describe your child's level of mobility

Describe your child's level of independence with dressing, showering, toileting, feeding

Sensory Concerns

Safety Concerns

Languages spoken at home

Anything else you would like to share about your child

I am interested in

Camp 18 Day CampCamp Lionheart Overnight CampSchool

Is your child currently enrolled, or have they previously been enrolled, in other KCC programs?

Currently EnrolledPreviously EnrolledNever

Please specify the program and year (Camp, Therapy, etc.)

Please list any questions or concerns.