Jackson Hole Leadership PHASE I APPLICATION
Contact us at (307) 733-6440 or
leadership@tyfs.org
* Required
Email address
*
Your email
Please mark your 1st Session Choice
*
Session 1: June 18-22 2018
Session 2: June 25-29 2018
Session 3: July 9-13 2018
Session 4: July 16-20 2018
Session 5: July 23-27 2018
Session 6: July 30-August 3
Required
Please mark your 2nd Session Choice
*
Session 1: June 18-22 2018
Session 2: June 25-29 2018
Session 3: July 9-13 2018
Session 4: July 16-20 2018
Session 5: July 23-27 2018
Session 6: July 30-August 3
Required
Please mark your 3rd Session Choice
*
Session 1: June 18-22 2018
Session 2: June 25-29 2018
Session 3: July 9-13 2018
Session 4: July 16-20 2018
Session 5: July 23-27 2018
Session 6: July 30-August 3
Required
Child's Name
*
Your answer
Gender
*
Male
Female
Required
Age
*
Your answer
Birthday
MM
/
DD
/
YYYY
Grade in School (Fall 2017)
*
Choose
5th
6th
Mailing Address
*
Your answer
Parent(s) Name(s)
*
Your answer
Email
*
Your answer
Best Contact Phone #
*
Your answer
Secondary Phone #
*
Your answer
Please check all that apply
My child has never spent a night away from home (without parents).
My child does not know how to swim.
Does your child have any dietary restrictions? If YES please explain.
*
Your answer
Are there any other concerns you would like to bring to our attention?
Your answer
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 we can best support your child's needs.
Yes
No
Payment
*
Submitting a check to HCC
Paying On-line with Credit Card
Applying for Full Scholarship
Applying for Partial Scholarship-See Scholarship Application
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