Youth Expedition Application
Deadline April 1st
Sign in to Google to save your progress. Learn more
T Shirt Size
Applicants may be Required to complete an interview. This will be conducted be via zoom. *
Commute Everyday or Stay in Dorm *
Student's First and Last Name *
Student's Date of Birth
MM
/
DD
/
YYYY
Student's Age
Student's Sex
Mailing Street Address, City, and Zip
Student Cell Number
Do you text?
Clear selection
Student Email Address
Parent's First and Last Name
Phone Number
Do You Text?
Clear selection
Parent Email Address
Relationship to Student
Name of High School
Present Grade or Equivalent
School Mailing Address, City, State, and Zip
High School Principal
Date Graduation Expected
Does your child have any allergies to meds or anything?
Clear selection
Common Reaction Symptoms
Clear selection
EpiPen required?
Clear selection
EpiPen at school?
Clear selection
Does your child need medication
Clear selection
If yes, list medication(s) with dose, time(s), and reason
Medical Conditions (Check all that apply)
Are they allowed to have?
Photo Release of over 18 permission can be granted by student at anytime: I give permission for Pervasive Parenting Center to take photographs and video of myself/ my child during camp activities and to post them on the PPC Facebook page and use them to promote future camps and programs. By declining photographs to be taken students will not be able to be in the group camp photo or any team photos taken. 

 *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms