Camp Sign Up

SIGN UP for Leadership Camp

-Those who are registering for the first time must fill out both the registration and health information forms. If you have registered in the past you don't have to fill out the health information again.
-More information about the camps can be found here
-Fee for full week of camp (Monday-Friday) - $250
-Early Drop-Off - $15
-Late Pick-Up - $25
-Choose your camp dates here

Registration Form

* Indicates required field

Student's Full Name *

First

Last

Prefer name: *

Age *

Grade *

Parent/Guardian Name *

First

Last

Parent/Guardian Name *

First

Last

Relationship *

Phone Number *

Relationship *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Address *

Line 1

Line 2

City

State

Zip Code

Country

Health Information

Medical Insurance *

Policy Number *

Name of Policy Holder *

First

Last

Primary Care Physician *

Office Phone *

Dentist *

Office Phone *

Hospital Preference (Choice #1) *

Hospital Preference (Choice #2) *

Does your child have an allergies or chronic illnesses? *

Does your child take any medications and/or have a medical plan on file at their school? If yes, please explain. *

Dietary Restrictions *

Activity Restrictions *

Please provide any additional information you would like the program staff to be aware of (special interests, fears, behaviors, custody arrangements, etc) *

IN CASE OF A MEDICAL EMERGENCY, EVERY EFFORT WILL BE MADE TO CONTACT THE PARENTS, GUARDIANS, AND EMERGENCY CONTACTS OF THE PARTICIPANTS. COMPLETED MEDICAL FORMS MAY BE PHOTOCOPIED FOR TRIPS OUTSIDE THE FACILITY, SO THAT ALL PERTINENT MEDICAL INFORMATION WILL BE PRESENT IN THE EVENT OF SUCH AN EMERGENCY. I AUTHORIZE YOUR BEST SHOT LEADERSHIP ACADEMY STAFF TO OBTAIN MEDICAL ATTENTION FOR MY STUDENT IN THE EVENT THAT I CANNOT BE CONTACTED IMMEDIATELY. MY SIGNATURE INDICATES THAT I HAVE READ AND UNDERSTAND THE PROCEDURES FOR THE LEADERSHIP PROGRAM.

Parent/Guardian e-signature *

Submit

SIGN UP for Leadership Camp

Registration Form

Health Information

CALENDAR