Selective Mutism CAMP Services Request Form

Rockville Therapy Center LLC is proud to offer the Confident Kids Camp DC Metro. Our 2024 5-day camp will be held on July 29-August 2, for ages 4-8 years. ***Please Note: Camp is FULL be we are accepting new individual therapy clients***

Please correct the errors described below.

Confident Kids Camp DC Metro Request for Information

Provide the name of the person/practice/website who referred you
write NA if not applicable
write NA if not applicable

What To Expect After Submitting Your Service Request Form:

Registration opens in January. If you contact us before then, you will be contacted in January. If registration is open, we should contact you within 2 business days. After this period, you may also follow-up with our Camp Coordinator at (fastest) or (301) 245-6260.

***Please Note: Camp is FULL.***

Submitting this Services Request Form does NOT confirm registration.

Detailed information about the Steps to Registration as well as answers to frequently asked questions (FAQs) can be found on our website at

Thank you from Rockville Therapy Center LLC!

Your information will be encrypted.