LifeWise | Youth Programs, Workforce Readiness & Community Impact

Early bird: Register by April 7, 2026 and save $10 on the registration fee!

Camper Information

Camper Full Name *

Date of Birth *

Age *

Current Grade *

School (optional)

Parent / Guardian Information

Full Name *

Relationship to Camper *

Primary Phone *

Secondary Phone

Email *

Home Address *

City / State / ZIP *

Emergency Contact (Other Than Parent/Guardian)

Full Name *

Relationship *

Phone *

Authorized Pick-Up

List anyone allowed to pick up the camper. Leave blank if parent/guardian only.

Medical & Safety Information

Allergies

Medical Conditions

Medication Needed During Camp

Dietary Restrictions (optional)

Permissions & Acknowledgments

Photo / Video Release *

Yes, I give permission for LIFE WISE to take and use photos/video of my child for camp-related and promotional purposes.No, I do not give permission.

Please check each acknowledgment *

I understand the registration fee is $25 per camper (or $15 if registered by April 7, 2026).I understand weekly tuition is $75/week half-day or $110/week full-day, and $65/week for each additional sibling.I understand payment is due at the start of camp and any day prior.I authorize LIFE WISE staff to obtain emergency medical treatment for my child if I cannot be reached.I understand campers are expected to follow staff instructions, respect others, and follow camp rules. Repeated unsafe or disruptive behavior may result in dismissal from camp.

Parent/Guardian Printed Name *

Date *

By submitting this form, you are providing your electronic signature and agreeing to all acknowledgments above.

Payment

After submitting this form, you'll be able to pay online to secure your spot. You can also pay anytime before camp starts.

Or pay now →

Summer Camp Registration