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Child's Name *
Child's Name
Parent's Phone Number *
Parent's Phone Number
Please provide both the full name and phone number of child's emergency contact (other than parent).
Workshop Registration *
Please select which workshop you are registering for.

Payment of $240 is due upon registration to hold your daughter’s spot. (Remember….you receive an additional 10% off for each other child or sibling you refer who registers. Your discounts can be paid back to you later once it is confirmed how many other participants you referred who registered) Payment and registration form must be received to reserve your daughter’s spot.  

You may pay over the phone by credit card by calling Michelle Smith at 704-301-5424 or you can send your payment in the mail with check to : 

Counseling Associates at the Lake, Inc. 
19501 W. Catawba Ave
Mailbox 10
Cornelius, NC  28031

**Healthy snacks and waters will be provided.  Please let us know if your daughter has any allergies or food restrictions.  Feel free to send your daughter with a snack of her own if you so desire** 
We are SO excited your daughter will be participating in this wonderful workshop series!  We are looking so forward to meeting your beautiful and strong “GIRL WARRIOR”!!!!!!