April 27 & 28, 2019

Please complete this application to enroll your child in this FREE day camp!

Camper Information


This Camp SAY Across the USA: DC online enrollment application must be completed by a parent or guardian. If you have any questions, please contact Taro Alexander, taro@say.org or 202.919.4848.

Camper Name*
Child's Gender*
Does your child stutter?*
Child's Date of Birth*
Campers must be 8-18 years of age, as of April 27th, 2019.

Parent/Guardian Information

Parent / Guardian*
Relationship to Child*
Home Address*
How did you hear about Camp SAY Across the USA: DC?*

Departing from Camp SAY Across the USA: DC

For Camp SAY Across the USA: DC, SAY staff has my consent to check out my child from camp in the following way:*
Please list ALL parents/guardians approved to pickup your child from camp (including yourself):
Approved Parent/Guardian #1*
Approved Parent/Guardian #2
Approved Parent/Guardian #3

Emergency Contact Information

Please provide two additional emergency contacts below (in case we are unable to reach you) in the unlikely event of an emergency.

Contact 1*
Contact 2*

Terms & Conditions

In accordance with applicable federal laws, SAY provides equal opportunities to employees and applicants without regard to age, race, religion, ethnicity, veteran status, disability, gender identity, or sexual orientation.

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