CO-ED YOUTH LEADERSHIP PROGRAM APPLICATION
(OPEN TO ALL ELIGIBLE MIDDLE AND HIGH SCHOOL STUDENTS)

TUITION & FEES

3-Month Program – $450, plus a $75 one-time non-refundable administrative fee, inclusive of all Camp S.W.A.G. t-shirt.

One-Year Program – $3,500, plus a $500 one-time non-refundable administrative fee, inclusive of all Camp S.W.A.G. uniforms. 10% discount for payment in full will be applied at checkout.

Sibling Discount

If you are registering siblings, please complete separate forms for each sibling. There is a 5% sibling discount for each sibling in the program.

For program qualifications, please visit Youth Leadership Program.

"Boys Are Debonair"

Leadership Program Application

PARENT/GUARDIAN INFORMATION

Referred by:

Full Name (1)*

Cell Phone (1)*

Full Name (2)

Phone (2)

EMERGENCY CONTACT (Not Parent/Guardian)

Name*

Cell Phone*

PARTICIPANT INFORMATION

First Name*

Last Name*

User Email*

Cell Phone (2)*

Street Address1*

Street Address2

City*

State*

Postcode / Zip*

Date of Birth*

School Name*

Grade Level*

List of current enrolled classes:*

Program of Interest*

3-Month Program (September 1st – November 30th )

3-Month Program (December 1st – February 28th)

3-Month Program (March 1st – May 31st)

3-Month Program (June 1st – August 31st)

12-Month Program (September 1 – August 31st)

Splitter

PARTICIPANT QUESTIONNAIRE

Please take a moment to answer the following questions honestly and in detail. This part of the application process is taken very seriously and we would love to hear your voice. This is an opportunity for the Youth Leadership Program Staff to get to know you a little better. This is an opportunity for self-refection and self-awareness.

What are your favorite classes?*

List of least favorite classes?*

What subjects do you feel you need help with?*

What subject(s) will you be volunteering to tutor with fellow leaders? (12-Month Leadership Program Requirement Only)

What three words come to mine when you think about leadership?*

Do you currently see yourself as a leader? Please explain your answer:*

What does being a leader mean to you?*

Name any leaders that you admire and explain why you admire them.*

Tell us a little about your likes and hobbies.*

What do you feel is/are the most important issue(s) that youth face today?*

Have you ever been bullied? If yes, how did it make you feel?*

Have you ever bullied any of your peers? If yes, how did it may you feel?*

Do you feel that you suffer from low self-esteem? If yes, please explain.*

Parent/Guardian and participant must esign below. By esigning, you agree to Camp S.W.A.G. Policy and Code of Conduct.

Participant Esignature*

Parent/Guardian Esignature*

Date*

Password*

Confirm Password*

You will now be re-directed to the "PAYMENTS" page to render payment for the Youth Leadership Program. Participation in this program is NOT complete until all payments and fees are paid in full.

Camp S.W.A.G. Policy and Code of Conduct
Leadership Program Application Disclosure

Co-Ed Youth Leadership Program Registration

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