Let’s start your Adventure!

Please fill out the form below and one of our Program Directors will be in touch!

Participant Name

First Name

Last Name

Participant Age as of June 21, 2023

Parent Email

Parent Phone#

(###)

###

####

Please check all that apply of the Summer 2023 Program Session Dates you would be able to attend

Session 1 | Wednesday June 21 - Monday July 3rd

Session 2 | Thursday July 6 - Tuesday July 18th

Session 3 | Friday July 21st - Tuesday Aug 1

Please select your #1 preference of Program Session Date

Address of Participant(s)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How did you hear about the Keala Foundation's Teen Initiative Adventure Program?

Participant #2 Name

First Name

Last Name

Participant #2 Age

Participant #3 Name

First Name

Last Name

Participant #3 Age