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Clay White, LLC.
Summer Camp
Full day summer camp for children receiving OT for SI issues
Programs
Outdoor programs, social programs, OT and SI programs, and more
Outdoor Sensory Adventures
PEOTSI® (PE/OT/SI) - Adaptive PE Program
Social Club Program
The Combine - Training for Heavy Kids
Summer Day Camp
About Us
Our professionals, contact and forms
Who Do We Think We Are?
Contact Us
Emergency Contact Form
Emergency Contact Form
Client First Name*:
Client Last Name*:
Parent First Name*:
Parent Last Name*:
Email*:
Address #1*:
Address #2:
City*:
State*:
Zip*:
Birthdate*:
[mm/dd/yyyy]
Of the following phone numbers, indicate the order you think we should call, i.e. most likely to reach someone.
Parent First Name*:
Home #1*:
Work #1:
Cell #1:
Person#2:
Home #2:
Work #2:
Cell #2:
Known Allergies, including insect bites, medications, food, etc.
Other pertinent medical history (i.e. medical conditions, seizure activity, etc.
Other comments.
Verification*:
Please type in the letters and digits shown below. (This is how we avoid spam emails)
07c50
ASA's National Program of the Year, 2005
Clay White (770)393-3939
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