Mental Health Family Day Camp/Information Request

**If this is an emergency, call 911. To speak with someone for immediate mental health support, please call 988 or 211. Requests made via internet are only checked during business hours.**

YSD Youth and Family Counseling
Mental Health Family Day Camp

Join us for a day full of therapeutic workshops and outdoor activities for families with children ages 5 - 17.

Parent Information

First Name

Last Name

Email Address

Phone Number

Child 1 Information

First Name

Last Name

Age

Grade

Child 2 Information

First Name

Last Name

Age

Grade

Child 3 Information

First Name

Last Name

Age

Grade

Child 4 Information

First Name

Last Name

Age

Grade

Child 5 Information

First Name

Last Name

Age

Grade

Service Requested (Select one):

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Mental Health Family Day Camp/Information Request

YSD Youth and Family Counseling Mental Health Family Day Camp

Parent Information

Child 1 Information

Child 2 Information

Child 3 Information

Child 4 Information

Child 5 Information

YSD Youth and Family Counseling
Mental Health Family Day Camp