Serving Travis and Williamson Counties, TX
512.584.1874
wholebodytheory@gmail.com
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About
Enrichment
Summer Programs
Home
About
Enrichment
Summer Programs
© 2026
WholeBody THEORY
Register for WholeBody THEORY Summer Camp
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Participant Information
Information about the student participant.
Full Name of Participant
*
First
Last
Participant's Date of Birth
*
Participant's Grade Level
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Activities & Programs Registering For (Check all that apply)
Afterschool Enrichment
Parent Day Out
Parent Night Out
Day of Play
Seasonal Camp
Other (list below)
Activities & Programs Registering For
If you selected ‘Other’ from above, please type in the name of the activity or program.
Parent/Guardian & Emergency Contact
Parent/Guardian Name
*
First
Last
Primary Contact
Parent/Guardian Email
*
Parent/Guardian Phone
*
emergency Grade apply)
Emergency Contact
*
First
Last
Relationship to Participant
Mother
Father
Grandmother
Grandfather
Sister
Brother
Aunt
Uncle
Other Relative
Emergency Contact Phone
*
Authorized Pick-up
*
Please list names of individuals authorized to pick up your child or children (other than parents/guardians/emergency contact listed). Use N/A if no other person is authorized.
Physical Health
Questions about the participant’s allergies and physical capacity.
Does the participant have any allergies or medical conditions?
Yes, I will provide the details
No
Does the participant take any medications regularly?
Yes, I will provide the details
No
Will the participant require accommodations to participate in physical activities?
Yes, I will provide the details
No
Do you give permission for emergency medical treatment if needed?
Yes
No
Do you give permission for your child to participate in physical activities?
Yes
No
Media & Participation Consent
Do you grant permission for photos/videos to be taken for program use (including marketing material)?
Yes
No
Permission & Agreement
*
I agree and give my permission
I give the youth participant stated here permission to attend this activity or program pursuant to all the terms and regulations that apply.
Payment
I agree to the following charge
*
Single Participant –
$260.00
Sibling Participant (price adjusted with coupon code) –
$260.00
Coupon
Apply
If using the Sibling Coupon Code, please list name of student participant already registered below.
Previously Registered Sibling
*
Use ‘N/A’ if coupon code not applied
Total
$0.00
Stripe Credit Card
*
Submit