2017 Western Heights Summer Leadership Registration
*This summer leadership opportunity is limited to students enrolled in Western Heights Schools*

Event Dates: June 12-15, 2017
Time: Breakfast at 8:00am, Camp 8:30am to 3:15pm (Final Day Extends to 7:30pm)
Event Address: Bridgestone Intermediate: 1700 S Council Rd., Oklahoma City, OK 73179
Contact us at (214) 636-6919 or hayley@loveworksleadership.org

Email address *
Experience Info
Parent/Guardian First & Last Name *
Your answer
Street Address *
Please note that the address provided will be the pick-up and drop-off location on file for students who request transportation.
Your answer
City *
Your answer
Zip Code *
Your answer
Parent/Guardian Mobile Number: *
Your answer
Parent/Guardian Email Address *
Your answer
Emergency Phone Number: *
Your answer
Student First & Last Name *
Your answer
Current Grade (Spring 2017) *
T-Shirt Size *
Please list any known student allergies.
Your answer
Western Heights Public Schools will be providing transportation for students who request it using this form. Please specify if your student will need transportation for both pick-up and drop-off, one or the other, or not at all. We will be using the address you provide in this form as the pick-up/drop-off location for summer camp. Information about bus route number will be sent home before camp.
Please let us know your student transportation needs. *
Concept Selection
Please refer to our website for descriptions of each concept. Once a concept is full, it will be removed from the drop down list.
Choose a concept *
A copy of your responses will be emailed to the address you provided.
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