Mindfulness Summer Camp Registration Form

Mindful Kids Summer Camp Registration Form

Thank you so much for choosing and trusting me with your child to help learn calming and focusing strategies, practice positive mindset, and deal with strong emotions. We will meet Monday - Friday, 9:00am to 12:00pm. Recommended for ages 7 - 11. The cost for one week is $215.00, which includes a daily snack and materials. Specific location (home address) and weekly agenda for the camp will be given after registration is complete and payment received. The camp will be taught by Chrystine Gonzalez, an educator for 29 years and a certified Life Coach and Mindfulness Coach. (Bio available upon request) Personal Contact Info: 801-558-3020
JULY 8th - 12th
Child Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent E-mail
example@example.com
Primary Contact Number
Format: (000) 000-0000.
We will primarily be doing stationary activities, such as breathing strategies, coloring, crafts, etc. We will occasionally do some mindful movement activities. Are there any physical limitations your child has?
A small snack will be provided each morning. Does your child have any special dietary needs? If so, please list below.
CONSENT AND AUTHORIZATION:

I, the undersigned, hereby declare and affirm that I am the parent/legal guardian of the Child named above, who is under my care and responsibility. I allow the participation of my Child in mindfulness activities which will be supervised at all times.

Payment is due at the time of invoice. 10 business days notice of cancellation is required to receive full refund. No refund will be given with less than 10 business days notice.

Due to low enrollment, the camp will be cancelled and my money will be fully refunded.
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Mindful Kids Summer Camp Registration Form