Laughing Body: Art of Care Registration

Please take a moment to complete this form and ensure your information is correct. If registering multiple participants, please fill out an individual registration form and payment infomation for each individual. * Required Fields  

The TOTAL COST for this trip is $800.00/each participant. 

 

Deposit is non-refundable.

Donation Amount*
  • Deposit (Non-Refundable, First Payment) - $200.00
  • Full Tuition (Total amount) - $800.00

Contact Information

Clown Name
Date of Birth*
Country*
State / Province*
Address*
City*
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Participant Email*
Confirm Email*
Primary Phone*

Additional Information

Please write a short description of yourself*
Have you done volunteer and social work in the past? How about as a clown? please describe:*
Would you be comfortable rooming with someone of another gender?*
How did you find out about the Laughing Body?*
Do you have any Health Concerns? Or Special Dietary Restrictions? Please include any Food Allergies.*
Dietary Preference (choose 1 option and mention exceptions/allergies above)*
  • Meat Eater (I eat everything)
  • No Read Meat (Fish & Poultry OK)
  • Poultry Only (No Red Meat, No Fish)
  • Fish Only (No Red Meat, No Poultry)
  • Vegetarian (No fish, poultry, or red meat)
  • Vegan (No Animal Products)
Languages Spoken*
  • English
  • Spanish
  • French
  • Italian
  • Chinese
  • Mandarin
  • German
  • Portuguese
  • Russian
  • Hindi
  • Bengali
  • Japanese
What is the best way and time to reach you?*
How did you hear about us?*
  • Friend
  • Social Media
  • Web Search
  • Newsletter
  • Other
Do you have any questions for us?

Travel Information

From which city will you depart?*
If you are traveling by train, what is your train number? What is your arrival time into White Sulphur Springs? From which direction?
If you are traveling by plane, what airline are you flying with? What is your flight number? What is your arrival time into Lewisburg Airport?

Emergency Contact Information

Please provide the contact information of a family member or close friend.

Emergency Contact Name*
Emergency Contact Relationship*
Emergency Contact Phone Number*
Emergency Contact Email*

Payment Information

Amount*
$
Name on Card*
Card Number*
Additional Comments

Security Code