Jackson Hole Leadership PHASE III Application
Contact us at (307) 733-6440 or
Boys: August 14-18 2017
Girls: August 7-11 2017
Date of Birth
Grade in School (Fall 2017)
Best Contact Phone #
Alternative Phone #
Please Check all that apply
My child has never hiked in the woods before.
My child has never spent a night away from home (without parents).
My child has never been on an overnight backpacking trip.
My child does not know how to swim.
Does your child have any dietary restrictions? If yes, please explain.
What sports/ physical activities does your child participate in?
Are there any concerns you would like to bring to our attention?
Does your child have a history of emotional, behavioral, family or school issues that you would like to discuss with a program leader prior to your session so that we can best support your child's needs?
Already submitted a check to HCC
Paying On-line with Credit Card
Applying for FULL Scholarship-See Scholarship Application
Applying for Partial Scholarship-See Scholarship Application
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