About Us
- Testimonials
Services
Insights
Contact
New Patient Forms

About Us
- Testimonials
Services
Insights
Contact
New Patient Forms

Blog

Thrive Summer Camp 2022

Thrive Summer Camp 2022 Registration is Open!

Registration is now open for Thrive Summer Camp 2022, hosted by Therapy & Wellness Connection. Headquartered at our Brecksville pediatric therapy clinic, kids of all ages & abilities are welcome. Camp activities are therapist-led, meaning our speech, occupational, physical, and ABA therapists design, lead, and supervise all activities. We welcome not only our patients, but their siblings, friends, and other kids in the Northeast Ohio communities of Brecksville-Broadview Heights, Cleveland, and Akron to join us for fun-filled days of crafts, games, and field trips that allow kids to explore the world around them, practice important life skills, and forge meaningful friendships and connections. Our camps fill up fast, so be sure to register as early as possible!

The Summer Camp 2022 Registration Form has been updated to reflect this year’s dates – June 13-Aug. 19th (off the week of July 4th) – with new themes each week. You can also visit our Thrive Summer Camp 2022 Page to learn more.

Summer Camp Form

Thrive Summer Camp Registration Form

Camper Information
Camper's Last Name*
Camper's First Name*
Camper's Middle Name/Initial
Is this your legal name?*
Gender*
Grade Level*
Shirt Size*
Date of Birth*
MM slash DD slash YYYY
Age*
Phone Number*
Address*
Street Address Address Line 2 City State ZIP Code
School District*
Referred to Thrive Summer Camp by:*
Please indicate the name of the person, health care provider or business that referred you to us or how you found us.
Other family members seen by us:
Insurance Information (if applicable)
(Please give your insurance card to the office manager.)
Person Responsible for the Bill
Date of Birth
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State ZIP Code
Phone
Is camper a patient here?*
Occupation
Employer
Employer Address
Street Address Address Line 2 City State ZIP Code
Employer Phone Number
Is this patient covered by insurance?*
Please indicate primary insurance:*
Subscriber's name
Subscriber's Social Security Number
Subscriber's Date of Birth
MM slash DD slash YYYY
Group Number
Policy Number
Co-payment amount
Camper's relationship to subscriber:
Secondary insurance (if applicable):
Secondary insurance subscriber name:
Secondary insurance group number:
Secondary insurance policy number:
Camper's relationship to secondary insurance subscriber:
Emergency Contact Information
Name of a local friend or relative not living at the same address:*
Emergency contact's relationship to the patient:*
Emergency contact's phone number*
Emergency contact's work phone number:
Consent*
I affirm that the above information is true to the best of my knowledge. I authorize my insurance benefits be paid directly to the physician. I understand that I am financially responsible for any balance. I also authorize Thrive Summer Camp or Therapy and Wellness Connection or insurance company to release any information required to process my claims.
Name of person completing this form:*
First Middle Last
Date this form was completed:*
MM slash DD slash YYYY
Choose Your Camp Weeks
Please Indicate all the 2022 Thrive Summer Camp Weeks in Which You Are Interested in Attending:*
- Select All
- Week 1 (June 13-17) Around the World
- Week 2 (June 20-24) Glow
- Week 3 (June 27-July 1) Grow
- Week 4 (July 11-15) Fishing (lower levels) Outer Space (upper levels)
- Week 5 (July 18-22) Bill Nye
- Week 6 (July 25-29) Nature & Me
- Week 7 (August 1-5) Carnival
- Week 8 (August 8-12) Under the Sea
- Week 9 (August 15-19) Habitats & Farm Life

Δ

If you don’t receive confirmation of your submission within 24 hours, contact us by calling (330) 748-4807 or emailing [email protected] to make sure we’ve received your registration.

Thrive summer camp 2022

Previous

Newer

Let's Connect

(330) 748-4807

10245 Brecksville Road. Brecksville, OH 44141

Services

Speech Therapy
Occupational Therapy
Behavior Therapy
Physical Therapy
Feeding & Swallowing Therapy
Social Emotional Learning
Educational Programs
Summer Camp

About Us

Therapy and Wellness Connection is a leading, innovative provider of Cleveland speech therapy, occupational therapy, physical therapy, behavior therapy, individualized education and supplemental support services for children and young adults with a broad range of delays, disorders and disabilities.

©2024 Therapy & Wellness Connection

Web Design by Go Media