2026 Summer Prevention Program Registration

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For Office Use Only

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Amount of Deposit

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Check #

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Venmo

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Cash

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Requesting Payment Plan

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Requesting Sponsorship

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Outside Agency Making Payment

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If Yes, Agency Name

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If Yes, Contact Name

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If Yes, Email

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If Yes, Phone

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(Staff Only) ID #

Participant Information

How’d you hear about us?(Required)

Grade in September

Have you attended an Initial Family Assessment at Sunshine?(Required)

Yes

If Yes, Please Add Date of Appointment(Required)

MM slash DD slash YYYY

Participant Name(Required)

First Last Name

Birthdate(Required)

MM slash DD slash YYYY

Age(Required)

Gender(Required)

Races(s)(Required)

Parent 1

Name(Required)

First Last

Email(Required)

Phone 1 (home/work/cell)(Required)

Phone 2 (h/w/c)(Required)

Parent 2

Name

First Last

Phone 1 (home/work/cell)

Phone 2 (h/w/c)

Camper lives with...(Check All That Apply)(Required)

Father

Mother

Stepfather

Stepmother

Other

If Other, please describe(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contacts

(Contact 1) Name(Required)

First Last

(Contact 1) Relationship(Required)

(Contact 1) Phone (h/c/w)(Required)

(Contact 1) May Pick Up?(Required)

Yes

(Contact 2) Name

First Last

(Contact 2) Relationship

(Contact 2) Phone (h/c/w)

(Contact 2) May Pick Up?

Yes

Session Information

Payment Options(Required)

$100 Advance Deposit (Amount will be applied to balance)

Payment in Full

Advance Deposit Policy(Required)

I understand and agree to this policy.

Advance deposit will hold your place but we can only confirm space once your registration has been paid for in full.

Program Cost: $300/3-day program, ages 5-16
Early Bird Discount of $25.00 per week before May 15, 2026

Please check sessions below. Each day runs from 9:00-2:00. Please note, there's a $150 discount if you book ALL SIX sessions.

* Please Note - the $150.00 Full Summer Program Discount will be removed if you make changes at a future date.

Sunshine Summer Camp 2026(Required)

Session 1: T/W/TH 7/7 – 7/9/25

Session 2: T/W/TH 7/14 – 7/16/25

Session 3: T/W/TH 7/21 – 7/23/25

Session 4: T/W/TH 7/28 – 7/30/25

Session 5: T/W/TH 8/4 – 8/6/25

Session 6: T/W/TH 8/11 – 8/13/25

Select Age Group (Age as of 7/9/24)(Required)

5 – 7

8 – 9

10 – 11

12 – 13

14 – 16

Medical Background

Please check the box if there’s been any history and include an explanation for each.

History/Background

Attention Deficit Disorder (ADD/ADHD)

Allergies (food/medication/seasonal)

Asthma

Autism Spectrum Disorder

Bone/Muscle Condition

Chronic Ear or Throat Infections

Diabetes

Dietary Needs

Mental and/or Emotional Problems

Fainting/sudden loss of consciousness

Frequent Headaches or Migraines

Head Injuries or Any Major Accidents

Physical Handicap

Seizure Disorder

Skin Problems

Vision or Hearing Problems

Hospitalizations and/or Operations

Are there any other concerns?

Please provide additional background for your selected medical conditions(Required)

Current Medications

Reason For Taking

Dosage/Frequency

Medication Type

OTC

Reason for Registering(Required)

Permissions

Please read each permission below and check each section in the appropriate areas.

I understand that if my child has been registered for the Summer Program, the space will be reserved for my child. Spaces are limited for every program at Sunshine Center. If you reserve a space for your child, that eliminates an opportunity for another child to attend. There is a $100 NON-REFUNDABLE DEPOSIT required for all participants in all programs. If you have registered and want to switch programs/weeks, Sunshine cannot guarantee this unless there are open spaces. If you have registered and paid for your child and you need to take your child out for some reason, you must give us TWO WEEKS notice in order for you to receive a refund (minus the $100 deposit). If you do not notify us, you will be responsible for payment in full. I understand and I am aware of this policy.

YES

I understand in the case of an emergency or a medical problem, Sunshine Center will do their best to reach me. If we are unable to reach any parent/guardians or emergency contacts, permission is granted for Sunshine staff and/or emergency medical professionals to make any decisions in the best interest of the camper.

YES

I give my child permission to engage in all program activities including games, snacks, lessons, and special guests. They will be supervised by staff members at all times.

YES

I understand that any group or program my child attends is not considered therapy or treatment. While your camper may experience positive benefits from this program, no particular outcome can be guaranteed. If you have any specific questions on the progress of your camper, you may talk with the facilitators and directors at any time.

YES

I understand that there may be photographs taken for Sunshine’s social media accounts. Pictures are taken at various times throughout the day during camp activities and trips, not only to keep parents informed, but also to promote our programming on social media. Please make the staff aware if you do not want your child involved in any photographs. If any media stories/news pieces are to be done on Sunshine, directors will let you know ahead of time and allow for you to make the decision for your camper to participate.

YES

I understand there are basic rules and guidelines that my child must follow. These rules and guidelines will be reviewed daily with all campers. Sunshine may not be an appropriate fit for all children. Some children may require a higher level of care. If for some reason this program is not suitable for your child, staff will reach out to you to discuss your options.

YES

I understand is not responsible for any technology or personal items brought to camp. We strongly suggest campers do not bring ANY personal items, especially technology. This interferes with their ability to interact socially and participate in the camp activities.

YES

I understand that this agreement is in effect from July 8 through August 14, 2025

YES

Name of participant's parent/guardian agreeing to the above permissions

Assessment Form (Optional)

Each applicant will need to complete the Assessment Form and send to Sunshine Prevention Center. OPTIONAL IF RETURNING - UPDATE AS NEEDED (DOWNLOAD FORM)

Consent(Required)

I have read and understand the notes below and agree that all information submitted here is correct.

IMPORTANT NOTES:

1.) We require a doctor’s note on letterhead if medication is required to be administered while at camp.

2.) You must provide us with a current copy of your child’s IMMUNIZATION RECORD by JUNE 15!

3.) If you need to fill out “Written Consent to Release Confidential Information” please ask a staff member. We will need one filled out for each agency or office who requests information from Sunshine on your behalf.

Session 1: T/W/TH 7/7 – 7/9/26

Price:

Session 2: T/W/TH 7/14 – 7/16/26

Price:

Session 3: T/W/TH 7/21 – 7/23/26

Price:

Session 4: T/W/TH 7/28 – 7/30/26

Price:

Session 5: T/W/TH 8/4 – 8/6/26

Price:

Session 6: T/W/TH 8/11 – 8/13/26

Price:

Session 1: Early Bird Discount

Price:

Session 2: Early Bird Discount

Price:

Session 3: Early Bird Discount

Price:

Session 4: Early Bird Discount

Price:

Session 5: Early Bird Discount

Price:

Session 6: Early Bird Discount

Price:

Advance Deposit

Price:

Payment for Full Summer Program ($150 Discount Applied)

Price:

Transaction Fee

Price: $0.00

(Fee to process the credit card transaction)

Total

Credit Card(Required)

Card Details

Cardholder Name

Additional Comments

Admin Code