Intake form

Intake Questionairre for KidsCampLive

* Indicates required field

Name *

First

Last

Age *

Date of Birth *

Last grade completed *

Books *

Activities *

Toys *

Foods *

Music *

Academic subjects *

Check if answer is Yes *

I will help my child get connect to Zoom An adult will be at home during Zoom camp I am available for parent/counselor conference if needed

Name *

First

Last

Phone Number *

Email *

Concerns *

Submit

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joan@kidscamplive.com and brianna@kidscamplive.com
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505-920-2385