LPEC 2025 Application

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Lesley Prather Empowerment Camp 20245 is scheduled for July 8 - 11, 2024, from 8 - 4 pm. Early drop-off/late pickup may be accommodated depending on scheduling availability.

Campers will report to Louisville Fire Academy at 1501 W Hill Street.

Camp is free! Uniforms, lunch, snacks and hydration will be provided.

If your camper has dietary restrictions/allergies, we ask that you pack her own lunch.

If your camper cannot attend each day, please do not continue with the application.

Participants will be chosen by a review panel.

Email *

Camper's Name *

Camper's Address *

Camper's Date of Birth *

YYYY

Camper's Current School *

Camper's Projected School in Fall 2025 *

Camper T-shirt Size *

Youth Medium

Youth Large

Youth XL/Adult Small

Adult Medium

Adult Large

Race/Ethnicity *

White

Asian

Hispanic/Latinx

Black or African American

American Indian or Alaska Native

Multiracial

Prefer not to say

Guardian/Parent Name *

Relationship to Camper *

Guardian's Email *

Guardian's Phone *

Allergies: *

My camper DOES NOT have any known allergies

My camper DOES have known allergies as indicated below

Food allergies (will pack own lunch)

Medication Allergies

Other Allergies

Required

Information you supply in this section will be referred to by LFD personnel for medications brought to camp and may also be shared with 911 response personnel and/or receiving hospitals in the event of an emergency. Any prescription medications brought to camp will be held by LFD personnel until needed. *

My camper does NOT take medication on a routine basis.

My camper takes medication regularly.

My camper will bring an epi-pen to camp.

My camper will bring an inhaler to camp.

Required

Medication & Relevant Health Condition

Developmental or Emotional barriers that may affect the camper's participation in the program:

How did you hear about LPEC? *

Teacher

Family Friend

Social Media

Vendor Fair

LRPFD Newsletter

What about Fire and Emergency Services interests you? *

Are you involved in your community through service or a group? *

Share sports and hobbies you enjoy. *

What would you like to gain from the LPEC experience? *

Please explain why you think LPEC will be a beneficial experience for you. *

Choose between the following topics to share about yourself. *

Describe someone you admire, your favorite qualities in this person, and how you can develop the same qualities in yourself.

Share something, somewhere, or someone you are afraid of. How does the fear feel in your body and mind? On a scale of 1-10, 10 being the most afraid, rate the fear.

Use this space to share your response. *

Please note that waivers releasing the Lesley & Rhyan Prather Foundation, Louisville Division of Fire and all associated parties will be signed and notarized the first morning of camp, on site, with a Louisville Fire Dept. Notary.

I understand.

Clear selection

At LPEC, your child may participate in any of the following activities:

Physical exercise including running, sit-ups, squats, lunges, push-ups, and yoga/stretching.

They may carry and/or push 20 lbs of equipment, advance a hose line with a partner/team, crawl through a dark room, ride in the bucket of an 85 ' ladder tower, ride on a fire rescue boat. All children participating in these activities will wear personal protective equipment and cannot participate unless wearing it properly. Please note no children are required to participate in any activity and will be permitted to sit-out as requested.

I understand.

Clear selection

A copy of your responses will be emailed to the address you provided.

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