Family Application, Agape Mindfulness Summer Program 2024

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Our mindfulness program will be the week of July 8-12 2024 at the United Parish of Auburndale in Newton, MA. Our hours are from 9am-3pm Monday-Friday. Children bring their own lunch and are provided a healthy snack. Children ages 6-11 are welcome to enroll in the program. We have full and partial scholarships for ALL families that have financial need. All donations to Agape are tax-deductible. Children ages 12-15 are welcome to apply to be Counselors in Training (CITs) and ages 16-adult are welcome to apply to be counselors for the program. Reach out to Rachel (rachel@agapewaltham.org) or Tara (tara@agapewaltham.org) with any questions or concerns. ¡También hablamos español!

Email *

Parent/Guardian Name: *

Parent/Guardian phone number: *

What is the full name of your child? *

How old will your child be in July 2024? *

Which school does your child attend during the school year? *

In which city/town does your family live? *

Which language(s) are spoken at home? *

Does your child have allergies? If so, please describe. *

What are some of your child's interests and strengths? *

Does your child have any special physical or health needs that we should be aware of? If so, please describe. *

Does your child have specific learning and/or behavior needs? If so, please describe. *

How do your family and your child identify racially, ethnically, and culturally? *

How does your child identify in terms of gender? *

Female

Male

Non-binary

Trans

Other:

Required

What are your child's pronouns?

Program tuition is $150 per child for the week. We have full and partial scholarships available for all families who need and request them. Because Agape Spiritual Community is a nonprofit organization, summer program tuition is considered a charity donation, and is therefore tax-deductible. If you are enrolling more than one child and paying full tuition for each child would be a financial burden, consider requesting a partial scholarship for each child. *

I am able to pay the full camp tuition ($150 per week per child).

I need to request a partial scholarship ($75 per week per child).

I need to request a full scholarship (no cost).

Send me a copy of my responses.

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