SUMMER PROGRAMMING 2026

SUMMER PROGRAMMING

Youth Application
Thank you for your interest in LifeWise StL's summer program for school-age youth. Enrollment for this program is first come, first served. To be considered for enrollment, please read the entire application and fill in all required fields* (marked with a red asterisk).

If you are applying for more than one child, please fill out this entire form; then, after hitting submit, there will be a link to complete the form again for each additional child. Some of the fields will prefill to save you time on each subsequent form. If anything is incorrect, you are welcome to erase the prefilled information and enter something else.

After you submit this form, a member of our staff will reach out to discuss your child's admittance to the program.
PARENT/GUARDIAN INFORMATION:
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
EnglishSpanishSomaliOther
YOUTH APPLICANT INFORMATION:
Basic Information
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Child's Shirt Size*
Health Information
Please list any health conditions, allergies, medications, and/or dietary restrictions:*
*If your child has asthma or severe food allergies, we must have an inhaler and/or EpiPen on site before you child can begin the program
School Information
Name of school currently attending*
Current grade level*
For the 2026-2027 school year
YesNoI don't know
If you have an electronic copy of your child's 504 Plan or IEP you may upload it here:

Cancelof
YesNoI don't know
If you have an electronic copy of your child's behavior plan you may upload it here:

Cancelof
What are some strategies LifeWise StL can use to best support your child's learning throughout the program? (ex: positive reinforcement, small groups, etc.)
LifeWise StL does offer therapeutic/behavioral support through individual therapy and social emotional skills groups. If interested in the possibility of individual therapy for your child, please email Meg Terranova (mterranova@lifewisestl.org).
Yes, swims very wellYes, but only knows basic swimmingNo
PREFERRED PROGRAM LOCATION:
LifeWise StL youth summer programming operates at multiple locations.

Based on your child's current grade, they'd be assigned the following site:
LifeWise StL youth summer programming operates at multiple locations.

Please select your preferred location below:
LifeWise StL (Grades 1-7) @ 1321 South 11th Street, 63104Maplewood UMC (Grades 1-4) @ 7409 Flora Ave, 63143Academy (Grades 8-12) @ 1025 Park Ave, 63104
We will do our best but cannot guarantee your preference. If your preferred site is full, staff will communicate with you about openings at other sites.
YesNo
How many years has your child participated in this program?
AFTERCARE:
This year, LifeWise StL is offering aftercare services for families who need it. Official summer programming ends at 3:30 PM, but parents may opt for youth to stay until 5:30 PM.

Aftercare services require an additional deposit of $20 per child per week due before the start of programming. This deposit is non-refundable regardless of attendance.
YesNo
TRANSPORTATION:
YesNo
If no, please provide an explanation:
Will be PICKED UP by an authorized personMay be TRANSPORTED home in the LifeWise StL van (if the service is available)Is allowed to WALK HOMEOther
*Transportation by LifeWise StL is not guaranteed and is only offered on a limited basis for families without other alternatives. Securing transportation from LifeWise StL requires a non-refundable deposit of $100.
Authorized Pick Up People

The parent/guardian listed above is automatically added to the child's list of authorized pick-up people. Please list 1-3 additional people whom you authorize to pick-up this child. All persons listed must be 18 years of age or older.
Person #1*

First NameLast Name
Relationship to Child*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Person #2*

First NameLast Name
Relationship to Child*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Person #3 (Optional)

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Person #4 (Optional)

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
*If you would like to authorize additional pick up people, you may submit their information in writing to your child's site coordinator
CONSENTS:
Transportation Consent

Certain program events may require authorized LifeWise StL staff to transport your minor child in a motor vehicle. Your child is expected to follow all applicable laws regarding riding in a motor vehicle and is expected to follow the directions provided by the driver. Your child's participation in the identified program event is not a requirement nor a right and their access to transportation can be revoked due to poor behavior.
Yes, I give permissionNo, I do not give permission
Consent to Participant in Mental Health Group

As a part of our summer program, your child may participate in a weekly mental health group during afternoon enrichment time. The group would be one hour each week and would focus on improving well-being and building coping skills. Depending on staff availability, this group may not be offered at every location. Additional information regarding this group is available upon request.
Yes, I give permissionNo, I do not give permission
Consent to Release Information

Maplewood aftercare services are separate from, and not provided by, LifeWise StL. Any agreement you have related to aftercare following the end of summer programming is solely with Maplewood United Methodist Church and not the responsibility of LifeWise StL. If you would like for your child to participate in aftercare programming at Maplewood, please consent to the following release of information, so that the information from this application can be shared with the staff providing aftercare services at Maplewood UMC, 7409 Flora Ave, St. Louis, MO 63143.
Yes, I give permissionNo, I do not give permission
Final Signature

I understand my signature below grants the permissions indicated above for the duration of my child's participation in LifeWise StL's 2025 Summer Program. I understand that I may revoke consent at any time by providing written notice to LifeWise StL but that revocation will not affect any activities conducted prior to receipt of the notice.
Signature of Parent/Guardian*

Clear
Date of Signature*

MonthDayYear
Date
Should be Empty:

SUMMER PROGRAMMING

Authorized Pick Up People

Transportation Consent

Consent to Participant in Mental Health Group

Consent to Release Information

Final Signature