Scheduling Application - The Jones Center for families

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Scheduling Application

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> > > Scheduling Application for LAC

Information & Guidelines for Application

• Scheduling is on a limited and first come, first serve basis
• A minimum of two weeks is needed prior to a requested scheduled date
• There is a fee associated with this program, & payment is due one week prior to the confirmed date
• All applications will receive a confirmation follow-up
• Cancellations must be within 48 hours of scheduled date for refund
• An inclement weather day will be rescheduled to a later date or canceled w/fees refunded

Application

Date of Application

Contact Person

List name if from an organization, club, business, etc.

Select one

Address

City

State

Zip Code

Phone

Home
Work
Cell
Fax

Desired scheduled date

First Choice

Second Choice

Please note: We only schedule groups on Thursdays, Fridays & some Saturdays.

Desired schedule time frame

Participants

Number of participants
Age range
Males
Females
Participant(s) w/Special Needs (please explain):

Objectives/goals

Team Building/Improving Communication & Cooperation

Building Self Confidence & Trust in Others

Problem Solving & Decision Making

Leadership

Improving Relationships

Other (please explain):

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