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Youth Program Registration

If you have questions or need any support registering, please call 866-442-3529 or email info@on-belay.org.

Have you registered your child(ren) for an On Belay program before?*
- Yes
- No
Your Name*
First Last
Any updates to the following:
- Phone Number
- Mailing Address
- Changes in family member's diagnosis
- Who in your family is affected by cancer
Email*
Please provide an email address at which we can send program information and updates
Enter Email Confirm Email
Phone*
Please provide a phone number at which we can call to share program information and updates
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Hidden
Unable to come to an in-person program? Would you like to request an 'On Belay in a Box: Spring & Summer Edition'' package?
Limit one per household.
- Yes
- No
Hidden
Would you like to register for Spring & Summer Programs?
- Yes
- No
Child's Name #1*
First Last
Please select the program(s) you'd like to register for:*
- Project Adventure: May 21, 2022
- *WAITLIST* The Browne Center: June 11, 2022
- Base Camp Adventure: June 28-30, 2022 (Ages 11-13)
- *WAITLIST* Teen Outdoor Adventure: July 25-28, 2022 (Ages 14-18)
Date of Birth*
Month
Day
Year
Age*
On Belay programs are open to youth ages 8-18
How are you related to child #1?*
- Parent
- Grandparent
- Step-parent
Would like to register another child?
- Yes
- No
Child's Name #2*
First Last
Please select the program(s) you'd like to register for:*
- Project Adventure: May 21, 2022
- *WAITLIST* The Browne Center: June 11, 2022
- Base Camp Adventure: June 28-30, 2022 (Ages 11-13)
- *WAITLIST* Teen Outdoor Adventure: July 25-28, 2022 (Ages 14-18)
Date of Birth*
Month
Day
Year
Age*
On Belay programs are open to youth ages 8-18
How are you related to child #2?*
- Parent
- Grandparent
- Step-parent
Would like to register another child?
- Yes
- No
Child's Name #3*
First Last
Please select the program(s) you'd like to register for:*
- Project Adventure: May 21, 2022
- *WAITLIST* The Browne Center: June 11, 2022
- Base Camp Adventure: June 28-30, 2022 (Ages 11-13)
- *WAITLIST* Teen Outdoor Adventure: July 25-28, 2022 (Ages 14-18)
Date of Birth*
Month
Day
Year
Age*
On Belay programs are open to youth ages 8-18
How are you related to child #3?*
- Parent
- Grandparent
- Step-parent
Would like to register another child?
- Yes
- No
Child's Name #4*
First Last
Please select the program(s) you'd like to register for:*
- Project Adventure: May 21, 2022
- *WAITLIST* The Browne Center: June 11, 2022
- Base Camp Adventure: June 28-30, 2022 (Ages 11-13)
- *WAITLIST* Teen Outdoor Adventure: July 25-28, 2022 (Ages 14-18)
Date of Birth*
Month
Day
Year
Age*
On Belay programs are open to youth ages 8-18
How are you related to child #4?*
- Parent
- Grandparent
- Step-parent
How has cancer affected your child(ren)*
- Family member in treatment
- Family member in remission
- Lost a family member
Who in your family is affected by cancer?*
As related to the child(ren) you are registering
- Mother
- Father
- Sister
- Brother
What type of cancer is effecting your family?*
What hospital or cancer center is providing or was providing treatment?*
How did you hear about On Belay programs?*

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Upcoming Programs

Project Adventure
Saturday, May 21, 2022
9:00pm-3:00pm
Beverly, MA

(Full) The Browne Center
Saturday, June 11, 2022
9:00pm-4:00pm
Durham, NH

Basecamp Adventure (Overnight)
June 28th-30th, 2022
9:00pm-5:00pm
Crawford Notch, NH

(Full) Teen Outdoor Adventure (Overnight)
July 25th-28th, 2022
9:00pm-5:00pm
Franconia Notch, NH

Support and Join

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Contact Us
On Belay Brochure

Mailing List

Contact

Email
Info@on-belay.org

Mailing Address
On Belay Inc
PO Box 391
Newmarket, NH 03857

Phone
1 866 44 Belay (866 442 3529)

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