Encanto Registration Form

Welcome to the Family Madrigal!

Join us here at TVP as we celebrate what makes each member of the Madrigal family unique and special while also learning some great mental health and wellness skills! We are excited to present our first Mental Health Workshop in a Summer Camp format.

Schedule: Elementary aged children

8:20am: Arrive, Check-in

8:30: Formal group check-in (1st day lay out rules etc.)

9-9:30: Learning section 1

9:30-10: Activity 1

10-10:15: Snack/ bathroom break

10:15-10:30: Learning section 2

10:30-11: Physical activity

11-11:30: Activity 2

11:30-12: Wrap up, review, provide tools for home

Middle school/ Junior High aged children: Afternoon schedule follows same format as above, starting at 12:20pm and running until 4pm

Cost: is $200 per child. Wanna bring a friend? We will be opening this up to non TVP patients on April 1st! Cost for non TVP patients is $250 per child.

For a full explanation of camp, including schedule of activities, please go to our website or click this link: MADRIGAL
Encanto Registration Form

Please fill out information for each child attending the camp
Child Name *

First Name Last Name
Child's date of birth

Month Day Year
Date
Is this child a TVP patient?

Yes (cost $200) No (cost $250)
AM or PM Session *
Please list any special needs/accommodations for your child:
(wheelchair, learning assistance, allergies etc)
Do you have more than 1 child to register?

Yes No

Additional Children
Additional Child Name (if more than one child)

First Name Last Name
Date of birth

Month Day Year
Date
Is your child a TVP patient?

Yes (Cost $200) No (Cost $250)
AM or PM Session
Please list any special needs/accommodations for your child:
(wheelchair, learning assistance, allergies, etc)
Additional Child Name (if more than 2 children)

First Name Last Name
Date of birth

Month Day Year
Date
Is your child a TVP patient?

Yes (Cost $200) No (Cost $250)
AM or PM Session
Please list any special needs/accommodations for your child:
(wheelchair, learning assistance, allergies, etc)
Additional Child Name (if more than 3 children)

First Name Last Name
Date of birth

Month Day Year
Date
Is your child a TVP patient?

Yes (Cost $200) No (Cost $250)
AM or PM Session
Please list any special needs/accommodations for your child:
(wheelchair, learning assistance, allergies, etc)

Collapse Stopper
Parent Name

First Name Last Name
Parent Contact Number
Parent Email
example@example.com
Covid-19 Safety Guidelines:

To ensure the safety of all attendees, only fully vaccinated children >5 years old will be able to attend. Proof of vaccination will be required and assessed on day 1 of the camp. Unvaccinated children will be turned away without return of fees.

Masks will be required for all indoor activities, but masks may be removed if desired for outdoor activities. If you have an immunocompromised child, please let our staff know so that we may discussed accommodations.
All fees for camp attendees are refundable until May 15th. Any cancellations after May 15th will not be refunded their camp fees.

After you submit your registration form, our office will be in touch with you via email or phone to confirm appropriateness for camp attendance and to collect fees as well as answer any questions you may have.

Submission of this form does not confirm acceptance into camp. We will contact you within a week of submission to confirm. Thank you so much for your participation in the process!
Parent Signature *

I have reviewed the Covid-19 safety guidelines and non-refundable fee policy and will abide by them as written. Clear
Should be Empty: