2024 Elements of Peace Application Form

Hello Elements of Peace Applicants!

Join us on a youth peace and wellness adventure founded in nature connection and the contemplative arts from diverse wisdom traditions. The main goals are to inspire stewards of the environment and leaders of a kind, peaceful, and resilient greater Charlottesville and world by:

1. Proactively responding to the youth mental health crisis through compassionate community, expert facilitators, and creative opportunities for youth to uncover meaning, resilience, and motivation for the year ahead

2. Bringing together diverse youth and cultivating deep and authentic relationships

3. Making peace a priority and kindness cool again! 

Please submit this application form to let us know of your interest in the program. We will send the final registration form to those admitted to the program. Please give us a 1-2 week turnaround to respond. For questions and more information you may contact us at elementsofpeaceprogram@gmail.com. 

Thank you for all you do to grow peace inside yourselves and in the world!

Program Details

Ages: 11-15 (12-14 recommended; Mature & enthusiastic 11 year olds as well as 15 year olds who may like to become mentors/counselors for future Elements of Peace programs are also encouraged to apply!)
Date & Time: August 10-11, 2024 (Drop off: 8:30AM; Pick up: 4:30PM)
Event Address: Camp Holiday Trails, Charlottesville, VA
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Parent/Guardian full name *
Email *
Participant full name  *
Participant age at the time of the program *
What grade will your child be starting in Aug 2024?
 *
What school will your child be attending in 2024?
*
What race/ethnicity(ies) best describe(s) your child? *
What gender does your child identify with? Please share anything you'd like us to know in this regard. *
Child's dietary restrictions and allergies *
What appeals to you most about this program? What is most exciting for your child about this program?  *
Is there any other information we should know about the child? *
Once we approve your application, we will send a secure payment link for $250.00 (+ online payment fees) to your email address. Scholarships are contingent upon funding. Please let us know, to cover the cost of the program, you will: *
Required
Finally, in case you know of anyone in your community who you think would love to know about this opportunity or donate to this program, please feel welcome to include their name and email below and we will send them the flyer (this is optional):
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