Summer Waitlist Form Parent/guardian Name * First Name Last Name Parent/guardian Email Address * Parent/guardian Phone Number (###) ### #### Closest Reach Centre * (Not all of our locations are offering summer camps) Edmonton North Vancouver Langley Richmond Ottawa Child's Name * First Name Last Name What is the age of your child? * Grade completed as of June 2024 * What is the preferred date and time that you are looking for? * Add multiple dates and times as needed. Is your child in French immersion? * Yes No Does your child speak English as a first language? * Yes No Does your child speak other languages at home? * Yes No Does this child receive learning assistance services at their school? * Yes No Has your child attended lessons at REACH before? * Yes No Has your child had any educational assessments? * Yes No Does your child have any allergies? * Yes No If you answered "yes" please explain... Does your child have any other medical issues? * Yes No If you answered "yes" please explain... Has your child's visual or hearing acuity been assessed? * Click all that apply Yes, visual acuity. Yes, hearing acuity. No Does your child suffer anxiety in any circumstances? * Yes No If you answered "yes" please explain... Does your child exhibit behavioural difficulties at home or at school? * Yes No Does your child exhibit attentional difficulties at home or at school? * Yes No If you answered "yes" please explain... Does your child take any medications or supplements? * Yes No Please list medications: Does your child exhibit compulsive behaviours or tics? * Yes No Please describe... Were you referred to Reach? * Yes No If so, by whom? Thank you for letting us know a little bit more about your child. You have now been added to our summer waitlist.We will be in touch if there is an opening.
