Summer 2025 Beach Bash Application

Thank you for taking the time to complete this form. This next section outlines important guidelines, expectations, and permissions to ensure a safe, supportive, and enjoyable retreat experience for everyone.

By participating in this retreat, we kindly ask that you review and agree to the following terms, including your commitment to maintaining a respectful and inclusive environment, acknowledgment of any potential risks, and understanding of our confidentiality policies.

Please read each statement carefully and indicate your agreement by checking the corresponding box.

This is round one for applications and you will be asked to submit to a 'get to know me' video. A Leia's Kids team member will reach out to you directly. 

If you have any questions or concerns about this section, feel free to contact us directly before submitting the form.

Dates: May 27th - May 30th, 2025

Location: Holden Beach, NC

Airport: Wilmington International - 1740 AIRPORT BLVD., SUITE 12 WILMINGTON, NORTH CAROLINA 28405

Age Requirements: 17-24

If you have any questions please reach out to info@leiaskids.org and we can help you. 

Thank You, 
Leia's Kids Team 
Sign in to Google to save your progress. Learn more
Application Submitted by
*
Required
Full Name *
Date of Birth *
MM
/
DD
/
YYYY
How are old are you? *
Current Mailing Address (FULL Address) *
Cell Phone *
Email *
Are you in high school, college or graduated?
Clear selection
I am a
Clear selection
T-Shirt size
Clear selection
Facebook Name / Link
Instagram
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Leia's Kids.

Does this form look suspicious? Report