Jackson Hole Leadership PHASE 2 APPLICATION

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Email *

Child's Name *

Child's Birthday *

YYYY

Please mark which trip You are applying for: *

Co-Ed: Jul 28- Aug 1, 2025

Co-Ed: Aug 4- Aug 8, 2025

Co-Ed: Aug 11-15, 2025

If you do not get in to the trip you applied for would you be interested in your child participating in one of the other week options? If so which week? *

If you will be registering one or more children besides your child listed above into camp we want to make sure to timestamp their names at the same time as this initial application (this can only be for your child NOT a friend). So please input other children you will be registering here. PLEASE STILL COMPLETE A REGISTRATION FOR EACH INDIVIDUAL ADDITIONAL CHILD.

Parent(s) Name(s) *

Email *

Best Contact Phone # *

Secondary Phone # *

Mailing Address *

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 previous major surgery, illness, or other medical history that may impact their ability to participate in any activities during the week? If YES please explain. *

Does your child have any Allergies? If YES, please explain triggers/symptoms and their severity/treatment. Will they carry personal allergy medications and/or an Epi Pen?
*

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 we can best support your child's needs. *

Yes

Has your child had a significant life event that continues to affect their life (death of a loved one, family change, adoption, new sibling, survived a disaster). Please answer yes or no.

-If YES, please consider providing information about the event below, as well as care tips, so that staff can best support your child.

Is there anything else you would like staff to know about your child?

Clear form

Never submit passwords through Google Forms.

This form was created inside of Teton Youth and Family Services.

Does this form look suspicious? Report

Forms