Referred by

PARENT/GUARDIAN INFORMATION

Full Name (1)*

Phone (1)*

Email*

Full Name (2)

Phone (2)

Email (2)

EMERGENCY CONTACT (Not Parent/Guardian)

Name*

Phone (3)*

PARTICIPANT INFORMATION

First Name*

Last Name*

Street Address1*

Street Address2

City*

State / Province*

Postcode / Zip*

Phone*

Email*

Date of Birth*

School Name*

Grade Level*

Required Confidential Medical Information

This information will be shared with staff only for the purposes of safely and effectively serving your child's needs. Please provide current information on your child's medical history and needs. *

Is student current on all school required immunizations?*

Yes

Any Allergies (insect, seasonal, medications, food, etc.)?*

List of current enrolled classes:*

Asthma (use inhaler or physically restricted?)?*

Medications (if yes, what for and will they be taken at camp?)?*

Hearing, Visual, or Physical Special Needs (wear glasses/contact lenses, physical restrictions)?*

Emotional Special Needs (Please describe)*

PARTICIPANT QUESTIONNAIRE

What are your favorite classes?*

What are your least favorite classes?*

Are you willing to tutor other students? Please list all subjects that you wish to tutor. If no, please explain. You will not be disqualified from the program if you do not wish to tutor other students.*

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

Do you currently see yourself as a leader? Please explain briefly.*

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

Why would you be a good ambassador for the leadership program?*

Why is it important for you to be an ambassador for Camp S.W.A.G.?*

What does being a leader mean to you?*

Name any leaders that you admire. Why?*

Tell us a little about your likes and hobbies.*

What are your favorite foods? Tell us about any food allergies.*

This section is optional. You may use this section to tell us more about yourself and your ambitions and goals.

Upload files - Letters of Recommendations (3), transcipts or current report cards, or any other files to help with your application.

How did you hear about us?*

BY SIGNING BELOW, ALL PARTIES AGREE THAT THEY HAVE READ AND AGREE TO ALL CAMP S.W.A.G. POLICIES, PROCEDURES, ACKNOWLEDGMENT AND ASSUMPTION OF RISKS & RELEASE AND INDEMNITY AGREEMENT LOCATED ON THE CAMP S.W.A.G. WEBSITE at Camp S.W.A.G. Policy and Code of Conduct.

Parent/Guardian and participant must esign below.

Participant Esignature*

Parent/Guardian Esignature*

Date*

User Email*

Password*

All Ambassadors Applicants much submit at least 3 Recommendations/References. Two (2) from school teachers and one (1) from a coach, counselor, principal, pastor, work supervisor, community member,
etc. (Please bring sealed references to interview or mail to Camp S.W.A.G., P. O. Box 480575, Los Angeles, CA 90048).

Please review the following:

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

Basic Membership Application

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT (Not Parent/Guardian)

PARTICIPANT INFORMATION

PARTICIPANT QUESTIONNAIRE

Like this:

Basic Membership Application

PARENT/GUARDIAN INFORMATION

EMERGENCY CONTACT (Not Parent/Guardian)

PARTICIPANT INFORMATION

PARTICIPANT QUESTIONNAIRE

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