Camp Gaines 2026 Registration Form

Name: Pillow Talk - A Safe Space for Mental Health Conversations
Start: 2024-10-17T18:00:00-07:00
End: 2024-10-17T19:30:00-07:00
Location: Renton

Dates: June–August | Time: 9:00 AM – 2:00 PM

Location: Wellness Gaines Fitness, Renton, WA

Ages: 6-12

Welcome!

Thank you for your interest in Camp Gaines 2025 — where movement meets mindfulness and learning turns into fun! Our summer program is designed to keep kids active, engaged, and supported in a positive, structured environment.

Please fill out the form below to register and submit payment. Spots are limited and confirmed only once payment is received.

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Welcome!

Thank you for your interest in Camp Gaines 2026 - where movement meets mindfulness and learning turns into fun! Our summer program is designed to keep kids active, engaged, and supported in a positive, structured environment.

Please fill out the form below to register and submit payment. Spots are limited and confirmed only once payment is received.

Pricing & Discounts

$200/week Standard Rate (After June 1)
$140 for the 4-day week: June 29 - July 3
Payments are non-refundable
All campers must bring their own nut-free lunch and water bottle daily

You will select your week(s) below and complete payment at the bottom of this form.

Parent/Guardian Information

First name

Parent/Guardian First Name

Last name

Parent/Guardian Last Name

Email

We’ll send all confirmation details and updates here.

Phone

Best number to reach you in case of questions or emergencies.

Address

Camper Information

Child’s Full Name

First and last name of the camper you’re registering.

Date of Birth

What grade will your child be in Fall of 2026?

T-Shirt Size

Additional Child Information (Optional)

Add the name(s), age(s) and T-shirt size(s) of any additional siblings you'd like to register.

Camper Needs & Safety

Allergies, Medical Conditions, or Medications?

Please list any food allergies, medical needs, or anything our staff should know.

Any Special Needs, Accommodations, or Notes?

Any specific needs, preferences, or info you'd like to share?

Emergency Contact Name

Emergency Phone Number

Relationship to Camper

Authorized Pick-Up List (Full Name & Relationship)

List up to 3 names (must show photo ID at pickup)

Waiver + Terms Agreement

I understand that my payment is non-refundable and secures my child’s place for the selected week(s) of Camp Gaines.

I understand that camp hours are from 9:00 a.m. to 2:00 p.m. and agree to drop off my child no earlier than 8:50 a.m. and pick up promptly by 2:00 p.m.

I understand that late pickups will result in a fee of $1 per minute after 2:05 p.m., billed to the parent/guardian. After 2:20 p.m., if the child has not been picked up, emergency contacts will be called.

I understand that my child must bring their own nut-free lunch and a water bottle each day.

I understand that disruptive or unsafe behavior may result in my child being dismissed from the program, and that no refunds will be given in such cases.

I give permission for Wellness Gaines staff to apply basic first aid (e.g., Band-Aids, ice packs) if needed. In case of emergency, I authorize staff to contact 911 and administer necessary aid until I arrive.

I agree to receive communications from Wellness Gaines regarding this registration. I authorize Wellness Gaines to communicate with me via email or phone regarding camp updates.

I confirm that only the listed individuals are authorized to pick up my child, and that a valid photo ID is required at pick-up.

Week Selection & Payment

Select Your Camp Week(s):

Week 1: June 22–26$200

Week 2: June 29–July 3$140

Week 3: July 20-24$200

Week 4: July 27-31$200

Week 5: August 3-7$200

Week 6: August 10-14$200

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Pillow Talk - A Safe Space for Mental Health Conversations

Thu, Oct 17

|

Renton

Join us for a supportive discussion on managing chronic stress and fatigue, featuring trauma healing expert Stephanie Campuzano, LMHC, CCTP. Learn holistic tools to improve mental health in a relaxed setting. Comfortable clothing and pillows are encouraged! Donations - Accepted

Tickets are not on sale

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Pillow Talk - A Safe Space for Mental Health Conversations

Time & Location

Oct 17, 2024, 6:00 PM – 7:30 PM PDT

Renton, 17110 116th Ave SE Unit A, Renton, WA 98058, USA

About the event

Join us for a transformative discussion on managing chronic stress and fatigue with holistic tools to support mental health. Led by Kyra Gaines, owner of Wellness Gaines Fitness, and featuring special guest Stephanie Campuzano, LMHC, CCTP, this event will explore the impact of trauma and stress on the body and mind. Stephanie, a licensed mental health therapist specializing in trauma healing, will share practical tools for addressing trauma from generational, childhood, sexual, and relationship experiences. Attendees are encouraged to wear comfortable clothing and bring a pillow for this relaxed, roundtable discussion.

We are also accepting donations to support the Keep A Breast Foundation, helping raise awareness and promote breast health.

Host: Kyra Gaines, Wellness Gaines Fitness

Special Guest: Stephanie Campuzano, LMHC, CCTP, owner of Invite Healing Therapy

This event has a group. You’re welcome to join the group once you register for the event.

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