Camper Application Part 1.
Thank you for your interest in Leadership Camp. Before you apply please know preference will be given to:
-- High school students
--Student's who identify as women
--Students who attend New York City Public Schools
--Students who have a demonstrated interest in leadership, mentorship and healthy living
--Students committed to attending at least one virtual info session.
--Families that have reviewed our Safety Policy and commit testing their child 72 hrs. before the session begins (if necessary).
Applications will be accepted on a rolling basis. Complete this form and send in your $40 refundable bus deposit to secure your spot today.
If you have any questions please feel free Josh Borkin via email (
)or phone at (646-241-0325).
TO BE FILLED OUT BY POTENTIAL PARTICIPANT
First and last name
When is your birthday ?
What is your email?
What is your phone number? (if you have one)
Which school do you attend? (please include full name ie. Brooklyn Preparatory Academy High school)
What grade are you currently in?
I identify as a
I consider myself
someone who likes to try new foods
someone who likes to eat the same things
I consider myself an
I consider myself an
Outdoor person/nature lover
I consider myself
This year I have been absent
More than 12 times
Less than 12 times
If you answered yes to the question above, is there a reason why you had more than 12 absences?
During Covid, I like to escape the world by
Playing video games
Watching shows on Nexflix or another streaming service
Getting on TikTok, Instagram or another social media platform
Reading books or listening to music
When I am not in school I don't like to be on screens
In what ways do you think Steve's Camp would benefit you?
Prompts: After a year of isolation, what do you look most forward to? Being outside? Around people? Away from Family?
How would you like to improve the world?
Prompts: What is an issue are passionate about and why? What would you like to explore more?
The part of Leadership Camp I most want to focus on:
Meeting professionals from fields I am interested in
Organizing a leadership event at Camp
Spending time with my peers
Talking about the issues that are most passionate to me
Making connections that will help me with college
TO BE FILLED OUT BY/ WITH A PARENT OR GUARDIAN
Parent/Guardian Name ( First, Last Name)
Parent/Guardian Email Address
Parent/Guardian Phone Number
What is your home address?
My Child receives special education services
If you checked yes, what accommodations would your child need while at camp.
In difficult situations my child tends to
Get quiet or shut down
Take their frustrations out on a sibling or family member
Escape to screens
Pretend nothing is wrong
Get angry with themselves or others
Covid-19 has impacted all of us? How do you think it has impacted your child.
They are more anxious
They they get down more and sleep more
They have "big emotions" more often
They are more prone to anger
I have not seen any major changes
Does your child take any medication that they will bring to camp? Please list them here.
I understand and agree to my child summiting a health screening just prior to leaving Steve's Camp.
I understand and agree to my child reviving a COVID-19 test during their time a Steve's Camp.
I will pay my fully refundable $40 deposit
Check: mail to Steve's Camp, 745 Westminster Road Brooklyn NY 11230
Money order: mail to Steve's Camp,
I request a deposit waiver (*This request implies that you will have to attend the camp session)
I affirm that I have truthfully answered every question to the best of my ability?
A yes answer will be considered the same a writing a signature
Any final questions, comments, or anything else that you would like us to know?
What Happens Next
Once you have filled out this form and send a bus deposit your spot is formally secured. Over the next few months/weeks be on we will send you.
--A medical intake/dietary restrictions form to fill out.
-- A code of conduct contract to sign.
--A schedule of digital Q&A sessions and intro workshops (you will be required to attend 1).
--A packing list and bus schedule.
If you are no longer interested in attending Steve's Camp we ask that you reach out promptly. Likewise Steve's Camp reserves the right to release your spot if we are unable to reach you throughout the process. Thank you again. We are soooo excited for the summer!!!!!
Steve's Camp at Horizon Farms | 745 Westminster Road Brooklyn, NY 11230| (646) 241-0325|
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