The Healing Center Live The Good

Saturday, April 18, 2026
9 - 11 a.m.
The Healing Center
11345 Century Circle W.
Springdale, Ohio 45246
Maximum Participants: 25

Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number Phone Number - ### - ### ####
Email
Adult T-Shirt size choice

Adult T-Shirt size choice XS S M L XL 2XL
Do you have friends/family that will be coming with you for this service opportunity? If yes, please let us know who. Do you have friends/family that will be coming with you for this service opportunity? If yes, please let us know who. First Last
Additional Guest 1 Additional Guest 1 First Last
Adult T-Shirt size choice

Adult T-Shirt size choice XS S M L XL 2XL
Additional Guest 2 Additional Guest 2 First Last
Adult T-Shirt choice

Adult T-Shirt choice XS S M L XL 2XL
Please list an emergency contact
Phone Phone - ### - ### ####
Please list any mobility restrictions, allergies, or other medical conditions that would be important for us to know:
What do you hope to give and/or get out of this experience?
By selecting the "yes" checkbox and typing your name in the box below, you are electronically signing the Volunteer and Waiver Form.

By selecting the "yes" checkbox and typing your name in the box below, you are electronically signing the Volunteer and Waiver Form. Yes No
Please sign your first and last name
How did you hear about this opportunity

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