Kinder Readiness Camp Registration
Please fill out the form below to sign your child up for our Kinder Camp. Be sure to select all of your preferred camp weeks. The cost is $100 per week per child and camp runs Tuesday through Thursday from 9:00am - 10:30am. If you have any questions, please reach out to jami@livempoweredcenter.com.
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Camper's Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Select Camp Weeks (Tuesday, Wednesday, Thursday only)
*
Week 1: I Can Do School! (July 7–9)
Week 2: Little Learners Launch (July 14–16)
Week 3: Confident Kinders! (July 28–30)
Coupon Code
Please enter a discount code
Total Camp Cost
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Please confirm that your child is independently potty trained
Yes
No
Please list any allergies or medical conditions
Additional comments or special instructions
Choose your payment option
Cash, Check or Step Up Funds
Credit Card
Payment Amount
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next
( X )
USD
Description
Credit Card
Register and Pay
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