Forms Draft Test Page

Member Information

Member's Name(Required)

First Last

Enter Member's Age(Required)

Please enter a number greater than or equal to 13.

What is the member’s age as of 1/1/2025? CEL services members starting at 13 years old.

Is the Member the Primary Contact?(Required)

Yes

No

Primary Contact Name:(Required)

First Last

Relationship to Member(Required)

Parent

Other Family Member

Other

Decribe Relationship(Required)

Primary Contact's Email:(Required)

Primary Contact's Phone:(Required)

Weekly Programs (18+)

Sunday Fun Day – $720

1/5-5/18 (18 weeks) | No program 3/30 & 4/20

Monday Night Bowling – $430

1/6-5/12 (15 weeks) | No program 1/20, 3/24, 3/31, & 5/5

Monday Night Sweet Treats – $450

1/6-5/12 (15 weeks) | No program 1/20, 3/24, 3/31, & 5/5

Tuesday Art – $540

1/7-5/13 (18 weeks) | No program 3/25

Wednesday Night Sampler – $540

1/8-5/14 (18 weeks) | No program 3/26

Thursday Guys Night – $320

1/9, 1/23, 2/6, 2/20, 3/6, 3/20, 4/10, 4/24, 5/8, and 5/15 (Mixer with Ladies Night)

Thursday Ladies Night – $290

1/16, 1/30, 2/13, 2/27, 3/13, 4/3, 4/17, 5/1, and 5/15 (Mixer with Guys Night)

Friday Night Social – $500

1/10 – 5/16 (17 weeks) | No program 2/7 & 3/28

Saturday Hangout – $990

1/11 – 5/17 (18 weeks) | No program 3/29

Saturday Out & About – $1250

1/11 – 5/17 (18 weeks) | No program 3/29

Sweetheart Dance (18+)

Sweetheart Dance – $30

Friday, 2/7 | 7pm – 9pm

Adult Events & Excursions (18+)

New Years Bash! – $40

Sunday, 1/5 | 5pm – 8pm

Round 1, Gurnee – $110

Sunday, 1/19 | 4:30pm – 8:30pm | *Excursion*

Go Bulls! – $40

Sunday, 1/26 | 5pm – 8pm

Winter Wonderland – $50

Sunday, 2/2 | 5pm – 9pm

Super Bowl Viewing Party – $50

Sunday, 2/9 | 5pm – 9pm

Painted Penguin Graffiti Workshop – $80

Sunday, 2/23 | 3:30pm – 6pm | *Excursion*

Mardi Gras – $50

Sunday, 3/2 | 5pm – 8pm

Butterhills Cafe – $60

Sunday, 3/9 | 10am – 12pm | *Excursion*

St. Patrick's Day CELebration – $50

Sunday, 3/16 | 5pm – 8pm

Pizza and a Movie – $100

Saturday, 4/5 | 4pm – 9pm | *Excursion*

Spring Fling – $40

Sunday, 4/6 | 5pm – 8pm

Everett Farms – $60

Sunday, 4/13 | 10am – 12pm | *Excursion*

Cinco de Mayo – $50

Sunday, 5/4 | 5pm – 8pm

Rock Through the Ages – $40

Sunday, 5/11 | 5pm – 8pm

Weekend Overnight Trip – 22+

Lake Geneva Winterfest – $820

Thursday, 1/30, 9am – Saturday 2/1, 5pm | *Vacation*

Grand Total

Teen/Young Adult Weekly Programs (13-22)

Monday Afternoon Hangout – $540

1/6 – 5/12 (14 weeks) | No program 1/20, 2/17, 3/24, 3/31, and 5/5

Tuesday Afternoon Hangout – $690

1/7 – 5/13 (18 weeks) | No program 3/25

Wednesday Afternoon Hangout – $690

1/8 – 5/14 (18 weeks) | No program 3/26

Thursday Afternoon Hangout – $690

1/9 – 5/15 (18 weeks) | No program 3/27

Friday Afternoon Hangout – $690

1/10 – 5/16 (18 weeks) | No program 2/7 and 3/28

Saturday Young Adult Explorers – $1890

1/11 – 5/17 (18 weeks) | No program 3/29

Teen/Young Adult Events & Excursions (13-22)

Be My Valentine – $50

Saturday, 2/15 | 5pm – 8pm

Great Wolf Lodge – $140

Saturday, 2/22 | 4:30pm – 8:30pm | *Excursion*

Spring Break Fun – $50

Saturday, 3/8 | 5pm – 8pm

Medieval Times – $140

Sunday, 4/6 | 3pm – 7:30pm | *Excursion*

Hakuna Matata – $50

Saturday, 4/19 | 5pm – 8pm

Countdown to Camp – $50

Saturday, 5/17 | 5pm – 8pm

Grand Total

Virtual Programs (All Member)

Sports Chat – Virtual Program – $90

Sundays, 1/5 – 5/18 (18 weeks) | 9am – 9:45am | No program 3/30 & 4/20

Disney Behind the Scenes – Virtual Program – $50

Mondays, 1/6 – 5/12 (15 weeks) | 3pm – 3:30pm | No program 1/20, 3/24, 3/31, & 5/5

Bingo Baby! – Virtual Program – $120

Tuesdays, 1/7 – 5/13 (18 weeks) | 5:15pm – 6:15pm | No program 3/25

Interactive Game Night – Virtual Program – $120

Thursdays, 1/9 – 5/15 (18 weeks) | 5:30pm – 6:30pm | No program 3/27

Dance Party! – Virtual Program – $120

Fridays, 1/10 – 5/16 (18 weeks) | 4:30pm – 5:30pm | No program 2/7

Grand Total

Payment Information

Grand Total

Financial Assistance (DO NOT check this box if you already receive Financial Assistance)

I am requesting Financial Assistance

*If you already receive Financial Assistance, DO NOT check this box.* | All requests for Financial Assistance will require proof of total household income for a determination to be made. New requests for financial assistance will likely delay the registration process and final placement in program cannot be guaranteed. We will reach out to you with more information. Financial Assistance is only available for two programs per session per member.

Payment Options(Required)

Payment in Full

Payment Plan*

*Payment Plans require a credit card saved on file. If you do not have one saved, we will reach out to for more information.

How do you want to split your payment?(Required)

2 month – January & February

3 month – January, February, March

4 month – January, February, March, April

Day of Month Charge (i.e. 1st, 15th, etc.)(Required)

Payment Type(Required)

Use Card On File

Use New Card – Contact me for card information

Send Invoice (Invoices are sent to primary contact email listed)

Last 4 digits of card on file:(Required)

FY25 Winter/Spring Registration Request

Member Information

Weekly Programs (18+)

Sweetheart Dance (18+)

Adult Events & Excursions (18+)

Weekend Overnight Trip – 22+

Teen/Young Adult Weekly Programs (13-22)

Teen/Young Adult Events & Excursions (13-22)

Virtual Programs (All Member)

Payment Information

You belong at CEL!

Enrich lives today!