Leadership Camp Dates: June 10 - July 26, 2024

A separate registration form must be completed for each camper.

Eligible applicants must be enrolled in 6th or 7th grade
Monday-Friday 7:30 AM- 5:30 PM
Transportation to and from the program will not be available.
Program location: Charlie Marshall Campus
Breakfast and Lunch provided

Program Enrollment Fees:

$350 per camper
All enrollment forms must be completed before the first day of participation.

Name of Parent/Guardian

First Name

Last Name

Relationship to Child

Name of Child

First Name

Last Name

Gender

Ethnicity

Child's Date of Birth

YYYY

If any, please list your child's physical/learning disabilities:

Please list any known allergies:

Please list child's social ability:

Please select your child's grade level

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Cellphone:

(###)

###

####

Work Phone

(###)

###

####

Alternative Contact Name

First Name

Last Name

Alternative Contact Phone Number

(###)

###

####

Emergency Contact Phone Number

(###)

###

####

In the event I cannot pick up my child; I authorize the following person(s)

Annual Household Income

Number of children under the age of 18 living in the home

Do both parents live in the home

Photo/Video Release:

Yes, I give my permission for my child to be photographed, sketched or videoed

No, I give my permission for my child to be photographed, sketched or videoed

Click Here to Print Application