TEEN EMPOWERMENT SUMMER CAMP $595 Dates August 9th-13th for Teen Empowerment Summer Camp Please fill out the form below * Required field Teen's Full Name* First Last Teen's Date of Birth* MM slash DD slash YYYY School Name* Teen's Grade* Any food allergies* Teen's Cell (if applicable)Teen's Email (if applicable) Mom's Full Name* First Last Mom's Email* Mom's Cell*Dad's Full Name* First Last Dad's Email* Dad's Cell*Parent's Relationship Status*MarriedSingleDivorcedWidowedTeen lives with the following family members (include age and relationship)*What made you register for the Teen Empowerment Summer Camp*What do you hope to get out of this week*Is there a topic you would like us to specifically cover to benefit your teenHow did you hear about the Teen Empowerment Summer Camp How did you learn about our program?* If it was through social media, who's account?
