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 19-23 2017
Session 2: June 26-30 2017
Session 3: July 10-14 2017
Session 4: July 17-21 2017
Session 5: July 24- July 28 2017
Session 6: July 31-August 4
Required
Please mark your 2nd Session Choice
*
Session 1: June 19-23 2017
Session 2: June 26-30 2017
Session 3: July 10-14 2017
Session 4: July 17-21 2017
Session 5: July 24- July 28 2017
Session 6: July 31-August 4
Required
Please mark your 3rd Session Choice
*
Session 1: June 19-23 2017
Session 2: June 26-30 2017
Session 3: July 10-14 2017
Session 4: July 17-21 2017
Session 5: July 24- July 28 2017
Session 6: July 31-August 4
Required
Child's Name
*
Your answer
Gender
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Male
Female
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Age
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Your answer
Birthday
MM
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DD
/
YYYY
Grade in School (Fall 2017)
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Choose
5th
6th
Mailing Address
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Your answer
Parent(s) Name(s)
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Your answer
Email
*
Your answer
Best Contact Phone #
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Your answer
Secondary Phone #
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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
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Already submitted a check to HCC
Paying On-line with Credit Card
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Applying for Partial Scholarship-See Scholarship Application
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