Brave & Becoming Summer Program Registration

Brave & Becoming Summer Program Registration

A transformational summer experience designed to help youth ages 10–14 build confidence, emotional awareness, leadership skills, healthy communication, self-esteem, and personal growth.
Parent/Guardian Information
Parent/Guardian Full Name

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Preferred Method of Contact
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Participant Information
Child’s Full Name

First NameLast Name
Preferred Name/Nickname
Age
Date of Birth

MonthDayYear
Date
Grade Entering Fall 2026
School Name
Pronouns (optional)
T-Shirt Size
Does your child have any allergies, medical concerns, dietary restrictions, or accommodations we should know about?
Program Interest & Support
What are you hoping your child gains from this program?
My child would benefit from support in:
Has your child participated in leadership, mentoring, or emotional wellness programs before?
Is there anything you would like us to know to better support your child?
Program Agreements
Please review and agree to the following statements:
Media Release
Do you grant permission for photos/videos of your child to be used for promotional or educational purposes related to the program?
Payment Information
A non-refundable $75 deposit is required to secure your child’s spot in the program if selecting a payment plan option.

Deposit will be applied toward the total program balance. Full balance is due by July 17.

Registration is not considered complete until the deposit or full payment has been received.

Due to limited enrollment, deposits are non-refundable and non-transferable.

Payment plans may be available upon approval.

Select Your Option

Brave & Becoming - Full

Full 3 weeks

$225.00

Brave & Becoming - Drop-in

Select the amount of weeks you are registering for

$95.00 Quantity

Brave & Becoming - Payment Plan

Non-refundable payment plan deposit

$75.00

Total

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Thank you for registering for Brave & Becoming. We are excited to support youth in building confidence, emotional awareness, leadership, courage, and healthy connections this summer.
Should be Empty:

Brave & Becoming Summer Program Registration

Parent/Guardian Information

Participant Information

Program Interest & Support

Program Agreements

Media Release

Payment Information

Select Your Option*

Select Your Option