Adult Chaperone Registration

Please select your payment type: You are sponsored or You need to make a payment.

* Payment Type:

Registration fee:

$150.00

Discount Total:

$0.00

Transaction Fee:

$5.73

Grand Total:

$155.73

Adult Registration Information

* First Name:

* Last Name:

* Address:

Address 2:

* City:

* State:

* Zip:

* Phone:

Cell Phone:

* Date of Birth:

* Gender:

* Email:

* How did you hear about Key Leader?

* Are you a member of:

Do you have any special needs (dietary or physical, etc) that we need to let the camp know about?

* Emergency Contact Name:

* Emergency Contact Phone:

* Relationship to Emergency Contact:

* Have you completed your background check?:

Billing Information Same As Above

* First Name:
* Last Name:
* Address:
Address 2:
* City:
* State:
* Zip:

Payment Totals

Sub Total:	$150.00
Sponsored:	$0.00
Registration Fee:	$0.00
Transaction Fee:	$5.73
Grand Total:	$155.73

Cancellation Policy

All CANCELLATIONS must be received in WRITING. You may email to carolinaskeyleader@gmail.com. Phone cancellations will not be accepted.

$25 of all registrations are non-refundable. Balance may be refunded from written requests received by 5 pm on Friday, April 12, 2024. No Refunds will be granted after April 12, 2024.

I acknowledge the cancellation policy for this event.

I acknowledge the Key Leader program has been designed as a complete educational experience from 4 pm on Friday afternoon through 11:30 am on Sunday morning. All participants are expected to attend the full experience and these values will be in effect during this whole time.

I acknowledge the Registration needs to be paid in full by April 6, 2024.

I acknowledge the following forms will be sent to me via email and they will be reviewed/completed by the start of registration at 4pm Friday.
-Medical Release Form/Rope Course Waiver
-Community Values
-YMCA Release and Waiver of Liability (Form A)

I acknowledge I am responsible for arranging my own transportation to and from camp.

I acknowledge I will have current background check cleared by Kiwanis (through Safe Hiring Solutions) completed 30 days prior to the start of the event.

Upon clicking 'submit' you will be directed to Paypal to pay any outstanding balance due.
our registration will not be complete until after that step.