Summer Camps 2011

Clear Horizons Academy is pleased to announce our Themed Summer Camps Program!

Sports and Games Camp Theater and Arts Camp

T, W, Th, June 14th – July 28th T, W, Th, June 14th – July 28th
9:00am-12:00pm 12:30pm-3:30pm
3:30pm
$550 total session* $550 total session*

Based on enrollment, students will be divided into groups of 66-
12 students and will work on developmentally appropriate
sports and games such as soccer, kickball, board games and
team building activities. The goal is to address skills in
flexibility, group problem solving, turn-taking
taking and emotional
conflict resolution. Camp located at Clear Horizons Academy:
5455 N River Run Dr., Provo, Utah.
Music and Movement Camp
Based on enrollment, students will be divided into group of 6- 6
12 students to work on developmentally appropriate theater
and arts activities.. Using scripts, role playing, painting, crafts
and other art projects, each child will focus on social
emotional skills, group problem-solving,
solving, and individual ideas and
creativity. Camp located at Clear Horizons Academy: 5455 N
River Run Dr., Provo, Utah.
Social and Floortime Groups

T, W, Th, June 14th – July 28th T, W, Th, June 14th – July 28th
9:00am-12:00pm 12:30pm-3:30pm
3:30pm
$550 total session* $550 total session*

Based on enrollment, students will be divided into groups of 6

6- Based on enrollment, students will be divided into groups of 6-6
12 students and will use music and movement to work on 12 students. Using play and child--led activities, students will
developmentally appropriate goals such as motor planning, work on individual social, emotional, communicative and other
speech and language, engagement, social communication and developmentally appropriate skills within the DIR/Floortime
regulation. Camp located
ted at Clear Horizons Academy: 5455 N Model. Camp located at Clear Horizons Academy: 5455 N
River Run Dr., Provo, Utah. River Run Dr., Provo, Utah.
*If you choose to combine two of the above themed camps, total cost is $1100 total session and children will also
eat lunch in appropriate social groups.
Outings Adventure Camp

Wednesdays, June 15th – July 27th

10:00am-12:00pm, Group 1
1:00pm – 3:00pm, Group 2
$225 total session
session, $714 for CHA paraeducator

Based on enrollment, students will be divided into groups of 5

5- 12 students. Students, caregivers and staff will venture on a
community outing for each session. Full description on page two.
**If youu choose to combine one of the Themed CCamps
amps with the Outings Adventure Camps, cost is $775.
$ If you
choose to have CHA provide a paraeducator in place of providing your own caregiver for the Outings Adventure
Camp trips, the cost would equal $1,264.
 Outings Adventure Camp
Full Description

Based on enrollment, students will be divided into groups of 6-12

12 students. Students, parents
and staff will venture on a community outing for each session. Each group will be assigned two
CHA staff members: one teacher and one paraeducator. In order to allow one-on-one
one
assistance as well as opportunities for caregiver training, networking and relationship building,
parents/caregivers get to attend WITH their child! By having a parent/caregiver attend the
community trips, CHA staff members will be able to focus on training and coaching each child’s
parent/caregiver on how to target goals, work through difficulties, and even experience
triumphs in community settings.

The main idea of this program is to provide students with new and exciting experiences that will
stretch their capacities, encourage flexibility and build rel
relationships
ationships with both peers and
caregivers attending the program. Each caregiver will receive weekly training ing handouts and
specific hands-on
on training in areas that are of most concern to them individually. Activities will
be based on parent input, experiences
nces that will help children grow
grow, and environments that will
provide good training moments for both students and caregivers.. Outings will include things like
hiking, bowling, swimming, museums, farms, and shopping centers, all tailored to each specific
group of children and their needs.

Each child enrolled* will be accompanied by a parent, grandparent, home

home-therapist,
therapist, sibling (if at
least 18 years of age), or neighbor. For an additional fee (to cover staffing costs), you may
request CHA to provide a staff member to attend with your child. To offer this exciting
training to parents, as well as to keep tuition as low as possible for families, we are offering two
different pricing options: one for families providing a caregiver, and one for families requesting
requestin
a CHA-provided paraeducator.

*Please note that only a caregiver may accompany your child each day. Additional siblings or friends not enrolled in
the program will not be able to attend. This is to help everyone focus exclusively on the individual goals and
a needs
of CHA Summer Community Camp students.

To register for any of the CHA Summer Camps:

Simply fill out the attached registration
egistration form, include payments and requested information, and
return it to CHA ASAP! First come, first served! Priority Regist
Registration
ration for current CHA
th
students is due by April 29 . After that, all open spots will be offered to non-CHA students.
 To complete your summer camp registration, please return
the following:
 Student Registration & Information (completed)
 Medical & Emergency Information (completed)
 $50 Deposit (non-refundable)

2011 CHA Themed Summer Camps Registration

Child’s Full Name: Currently attending CHA

Former CHA Student
New CHA Student
Non-CHA Student
Date of Birth: Gender:
 Male Female
Student Information

Home Address: Home Phone:

Mother’s Name: Mobile Phone:

Employer Name: Work Phone:

Employer Address: Email:

Father’s Name: Mobile Phone:

Employer Name: Work Phone:

Employer Address: Email:

Check To
Options Dates Days Times Costs
Register
Sports and June 14th – 9:00am- $550 total session
T,W, Th
Games Camp July 28th 12:00pm
Themed Summer Camps

Theater and $550 total session

June 14th – 12:30am-
Arts Camp T,W, Th
July 28th 3:30pm
Music and $550 total session
June 14th – 9:00am-
Movement T,W, Th
July 28th 12:00pm
Camp
Social and $550 total session
June 14th – 12:30am-
Floortime T,W, Th
July 28th 3:30pm
Groups
Outings $225 total session or
June 14th – 10:00am-
Adventure W $714 for CHA para
July 28th 12:00pm
Camp
Outings $225 total session or
June 14th – 1:00pm-
Adventure W $714 for CHA para
July 28th 3:00pm
Camp

Page 1 of 2
 Outings Adventure Camp Registration  I will provide my own caregiver for CHA’s Outing Adventure Camp, and have provided the
caregiver information below. I understand that while the caregiver can change from week to week,
to help maintain consistency for my child, no more than two individuals will attend with my child
throughout the course of the program.
 I would like Clear Horizons Academy to provide my child with a paraeducator to attend the Outings
Adventure Camp with. I understand my tuition will be higher, as described above.
 I will not be enrolling my child in CHA’s Outing Adventure Camp.
Caregiver #1 Name: Relationship to Student:
Only

Home Address: Home Phone:

Email: Mobile Phone:

Caregiver #2 Name: Relationship to Student:

Home Address: Home Phone:

Email Mobile Phone:

Note: No financial scholarships will be available for 2011 summer camp attendance. For a list of
ways to find other sources, please see attached page.

I understand that by registering for Clear Horizons Academy’s Themed Summer Camps, I
am asking CHA to reserve a spot for my child (and a caregiver, if enrolled in the Outings
Adventure Camp) to attend for the summer of 2011. If I later choose not to send my child, I
understand that I will be forfeiting my $50 non-refundable deposit, and will need to notify
CHA as soon as possible.
Parent/Guardian Signature Date

CHA Building Fund Contribution

I would like to make a contribution to the new facility being built for Clear Horizons
Academy that will provide many more students the opportunity to receive individualized
education both in the summer and following school years. Included with my Registration
Deposit you will find $_____________ to go towards the CHA Building Fund.

Signature: _______________________________________

Date:________________________________________

Page 2 of 2
 Medical & Emergency Information: 2011 Summer Camps
Student’s Name (First, Middle, Last): Gender: Date of Birth:
 Male  Female
Address (Street, City, State, Zip): Home Phone:

Mother’s Name: Work Phone: Mobile Phone:

Father’s Name: Work Phone: Mobile Phone:

Physician Name: Phone Number: Allergies (please list):

 Medical:____________
Physician Address (Street, City, State, Zip): __________________
 Food: ______________
Dentist Name: Phone Number:
__________________
 Plant: _____________
Dentist Address (Street, City, State, Zip):
__________________

Current Medications:
 Animal: ____________
__________________
 Other: _____________
__________________
__________________
Please list any other medical conditions your child may have and/or things the school and/or doctors may need to know about your child:

If you cannot be reached in an emergency situation, please list two people we can call who can
assume responsibility for your child:
Contact Name: Relationship: Phone: Alternate Phone:

Contact Name: Relationship: Phone: Alternate Phone:

In an emergency or urgent situation, if I/we cannot be reached, I/we authorize Clear Horizons
Academy to contact his/her Pediatrician and/or Dentist. This paper will provide the doctor(s) and/or
emergency teams with permission to treat my child. I also accept full payment and liability for
accident or injury incurred while at school understanding that the school will do its best to keep my
child safe, but accidents and injuries do happen.
Authorized Representative Name (please print): Relationship to Student:
 Parent  Guardian  Other:
Signature: Date: