Please print clearly and complete a separate registration form for each camper. All campers must submit the All Camps Registration Form and Payment Form along with this registration.

Child’ s Name:________________________________________ Birthdate:___________________ Grade( Fall‘ 17):________ ���Member ���Non-Member

We are pleased to offer this opportunity. However, there are limited spaces available and in order to accommodate the most campers, enrollment is limited to two weeks. A fifty percent deposit is required with this registration. The deposit will be refunded if your child is not selected for Voices Together. If your child is selected the balance must be paid in full by June 2, 2017. Fees may be charged on MasterCard, American Express or Visa or paid by Electronic Funds Transfer( EFT). There will be no refunds after June 16, 2017.

Peer Camper Application

( no fees apply)

Peer campers must also complete the All Camps Registration Form( page 25)

To be considered for this program, peer campers should be in the 8th grade or higher. When the camp is full, peer camper applicants will be placed on a waiting list.

Select which weeks you are interested in as a peer camper: ��July 24- 28 ��July 31- August 4 ��August 7 – 11

Please list your experience working with children with Autism:___________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________

Please describe your interest in working at Voices Together:_____________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________

Important things to bring to camp: Smile, promptness, flexibility, patience, hearty lunch, bathing suit / towel and lots of energy!

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Fax or Mail your Peer Camper Application to:

Melissa Bunce, Weinstein JCC Director of Inclusion and Support Services 5403 Monument Avenue • Richmond, VA 23226 • Phone:( 804) 545-8658 • Fax( 804) 285-3139