Jackson Hole Leadership PHASE II Application

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Email *

Please select which trip you applying for *

Girls: July 31-Aug 4 Trail TBD

Boys: August 7-11 Trail TBD

Girls: August 14-18 Trail TBD

Boys: August 21-25 Trail TBD

Child's Name *

Date of Birth *

YYYY

Mailing Address *

Parent(s) Name(s) *

Email *

Best Contact Phone # *

Alternative Phone # *

Please Check all that apply

My child has never hiked in the woods before.

My child has never spent a night away from home (without parents).

My child has never been on an overnight backpacking trip.

My child does not know how to swim.

Does your child have any dietary restrictions? If yes, please explain. *

Does your child have any allergies? If yes, please explain. *

What sports/ physical activities does your child participate in? *

Are there any concerns you would like to bring to our attention?

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 that we can best support your child's needs? *

Yes

Required

Payment *

Submitting a Check to HCC

Paying On-line with a Credit Card

Applying for FULL Scholarship-Must Complete Scholarship Application

Applying for Partial Scholarship-Must Complete Scholarship Application

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