Summer Experience Registration – The Living Wells Community & Development Center

Campers Name

First

Last

Campers DOB (00/00/0000)

Parent/Guardian Name

First

Last

Parent/Guardian Email

Confirm Email

Parent contact information (phone number)

Name serves emotional

Address

Emergency Contact Name

First

Last

Emergency contact phone number

Allergies, medical needs, or other notes (food, transportation, emotional support, etc.)

6-Week Summer Day Camp – Registration Deposit ($150)

This $150.00 registration deposit reserves a participant’s spot in the Living Wells Summer Experience. The total program cost is $1,500. The remaining balance of $1,350 is due prior to the start of the program and covers program activities, field trips, transportation, and meals.

Minimum Price: $150.00

By typing my full legal name below, I acknowledge that I am the parent or legal guardian of the participant and that my typed name serves as my electronic signature for this registration and payment authorization.

Stripe Credit Card