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Summer Camp for Seniors Registration
Welcome to AgeWell's first Summer Camp for Seniors! Please complete this form and an AgeWell representative will contact you for more information. Thank you and we look forward to working with you!
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Email
*
Record my email address with my response
Your name
*
Your answer
Your telephone number
*
Your answer
Camper/client's name
*
Your answer
Camper/client's physical address (We serve Boyle, Lincoln and Mercer Counties)
*
Your answer
Your relationship to camper/client
Your answer
What camp week(s) does the camper/client plan to participate (campers who register for all 6 weeks will receive a 10% discount). Check all that apply
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Week 1 (week of June 17th)
Week 2 (week of June 24th)
Week 3 (week of July 8th)
Week 4 (week of July 15th)
Week 5 (week of July 22nd)
Week 6 (week of July 29th)
Not decided yet
Required
How did you hear about AgeWell
Your answer
Misc. information you want to share
Your answer
Submit
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