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Enlighten Your Life

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Registration

First name*

Last name*

Phone*

Email*

Emergency Contact Phone Number*

Second Emergency Contact Phone Number

Are You using child care?*

Yes

No

Allergy & Medical Information

Food Allergies*

No Allergy

GF

Dairy Free

Vegan/Vegetarian

Nuts

Choose from the following*

2 Days with Overnight

2 Days

One Day Saturday

One Day Sunday

Please go to https://www.thewanderingkayak.com/waiver to complete our Waiver Then press "Submit" below

EST 2022 in Theresa New York

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