Kids/Teens Summer Camps
Which summer camp are you registering for?
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Building Up: Battling Big Emotions-June 6th-10th
Kids Conquering Anxiety-June 6th-10th
Resilient Teens-June 13th-17th
Participant Information
Child First Name:
*
Child Last Name:
*
Gender:
*
Please Select
Male
Female
Guardian First Name:
*
Guardian Last Name:
*
Relationship to Client:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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-
Area Code
Phone Number
Email
*
example@example.com
Participants Date of Birth:
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Month
-
Day
Year
Date
Participant's Grade for 2021/2022 School Year
*
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
School:
*
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Payment Agreement
Payment is required prior to beginning of camp and no other payment is required. If your child is not accepted into the group you will be refunded the full amount.
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Building Up Battling Big Emotions-June 6-10th
$
100.00
Kids Conquering Anxiety-June 6-10th
$
100.00
Resilient Teens Middle School Group-June 13-17th
$
100.00
Total
$
0.00
Proceed to Payment
Should be Empty: