Virtual Activities

October Virtual Activities*
Select The Date/Time for an AM or PM Group. These classes are a 4 day series.

Your Name*
First Last
Email*
Participants Name*
First Last
Participant Age*
Is the Participant a past MHKC Camper*
- Yes
- No
Is the Participant going to be utilizing extra support from someone (participant provided) during the activities?*
- Yes
- No
Please explain in detail what (Participant provided) extra support may be needed.
Do you have access to a printer?*
- Yes
- No
Do you have a Zoom account or have you used Zoom before?*
- Yes
- No
- Need More Information

Will you be paying privately or billing to brokerage?
Invoice will be sent through email from Square. This will need to be paid in full 7 days before the first class. If you need a payment plan, please sign up and contact Kathy Werschkul after submitting the form. Thank you
Brokerage Details
Brokerage Name
Brokerage Personal Agent Name
Brokerage Personal Agent Phone Number
Brokerage Personal Agent Email
Brokerage will be billed for 4 hours. Please contact your brokerage and add us as an approved provider if you already haven't done so to ensure processing. Thank you

Virtual Programming