Discovery Camp Registration

Discovery Camp Registration

Please fill out the form below to sign your child up for our Discovery Camp. Be sure to select all of your preferred camp weeks. The cost is $130 per week per child and camp runs Tuesday through Thursday from 9:00am - 11:30am. We offer a $25 sibling discount, and if you pay with cash or check, we will provide a $15 weekly discount. If you have any questions, please reach out to jami@livempoweredcenter.com.
Parent's First Name
Parent's Last Name
Parent's Email Address
example@example.com
Parent's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Camper's Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Camper's Grade (Entering)
Does your child have any allergies?
What are your educational goals for your child from attending our summer program?
Select Camp Weeks (Tuesday, Wednesday, Thursday only)
Coupon Code
Please enter a discount code
Total Camp Cost
Choose your payment option

USDDescription