Register For April Break 2025 Camp Here: 

First Name:
Last Name:
Email Address:
Phone Number:
Address:
City, State, and Zip Code:
Age:
Birthday:
Gender:
Preferred Pronouns:
Parent/Guardian Name:
Parent/Guardian Address (if different from above):
Parent/Guardian Phone:
Parent/Guardian Email:
Parent/Guardian Name 2:
Parent/Guardian Address 2 (if different from above):
Parent/Guardian Phone 2:
Parent/Guardian Email 2:
Please provide the name and phone number of someone who we may contact in the event of an emergency and the parent/guardian(s) listed cannot be reached
Emergency Contact Name:
Relationship to Camper:
Emergency Contact Phone Number:
Transportation Alert: This alerts us to people you DO Not want to pick up your camper. As a parent or legal guardian, I DO NOT authorize my camper to be released to/ picked up by the following persons:
Names:

Camper Profile

Camper's Primary Doctor:
Doctor's Phone Number:
Does this camper have seizures?*:
If yes, please list the type and duration of seizures and the seizure protocol you follow:
Does this camper have allergies?:
If yes, please list all allergies:
What are your camper's likes and dislikes?:
Camper diagnosis/diagnoses:
What is your camper like behaviorally? Please include all strategies that work well when engaging your camper if they are having difficulties:
What is your camper like in a group setting?:
Will this camper need to take medication during camp hours?:
If yes, please list all medications::
Does this camper need support in the restroom?:
Does this camper have a history of elopement/bolting away?:
Does your camper have any challenges with community safety skills that we should be aware of? If so, please list them below and any tips/tools that work best for them:
How did you hear about STRIVE/Camp STRIVE:

April Break Camp 2026 Dates

Camp days are split into morning session (9:00 a.m.–1:00 p.m.) and afternoon session (1:00–5:00 p.m.). Campers may sign up for the full day or a single session. Please review the camp days below and list which sessions you'd like to sign up for in the space below. (Make sure to indicate morning session, afternoon session, or full day!)
Monday, April 20 (morning, afternoon, or full day):
Tuesday, April 21 (morning, afternoon, or full day):
Wednesday, April 22 (morning, afternoon, or full day):
Thursday, April 23 (morning, afternoon, or full day):
Friday, April 24 (morning, afternoon, or full day):

April Camp STRIVE Releases

I hereby release PSL Services/STRIVE, and its employees/volunteers of any responsibility or liability for any injury and/or illness derived from participation in the Camp STRIVE program:
I hereby give permission for my camper to participate in any off site field trips which are part of the Camp STRIVE program:
I give consent for transportation to a medical facility (by ambulance or employee vehicle) in the event of an emergency:
I understand that the permission I have given by signing this form is a material inducement to acceptance of my camper as a Camp STRIVE participant. I also confirm that I have given PSL Services/STRIVE complete and accurate information on my child:
I understand that I am responsible for payment of any and all days registered unless given notice of schedule change to staff by the end of the day prior to scheduled session:
Pictures of camper and camper's activities may be taken and used for publicity purposes including but not limited to publications in commercial periodicals and program newsletters:
Release and Consent Form Parent/Guardian Signature:
Release and Consent Form Date:

Member photo

While it is not required, we strongly recommend uploading a recent photo of the member. Our staff gets to know every member personally, but having a photo onfile makes it easier for our whole team to familiarize themselves with members they may not interact with as often, provide more personalized support, and maintain a safe environment for all.
Please opt to upload a recent photo of the member:
Once you hit the submit button, a STRIVE staff will reach out within one business day to confirm your registration. You will also be sent an invoicefora deposit to hold your spot. If you are attending for a full week or more, the deposit is $300 (one full week of April Break Camp STRIVE). If you are attending for less than the full week, your deposit will equal your total payment.