Registration

Location: Northport Wellness Center
220 Fort Salonga Rd, 3rd Floor, Northport, NY 11768

Limited Space Available.

First Name *

Last Name *

Email

Date of Birth

Phone *

Caregiver's First Name

Caregiver's Last Name

Caregiver's Email

3 Day Group Sessions including Refreshments $250

Ages 11-14: August 14th, 21st and 28th from 3:00PM-4:30PM

Ages 15-17: August 11th, 18th and 25th from 4:00PM-5:30PM

Credit Card Payment

Billing Address

City

State/Province

Zip/Postal