Leadership Program Application

Step 1 of 5

Leadership Program Application

This online application will take a few minutes to fill out. At the end of the form you will submit the application to us and you will receive a confirmation email.

Please be frank and honest in completing each question; there are no wrong answers.

The form WILL ask you for two references; Teacher (If you are in school, or else someone who can tell us you are smart); Pastor (someone who can tell us about your spiritual life). Have these e-mails addresses ready to go as a reference form will be automatically sent to your references when you submit this application. It also MIGHT be a good idea to let your references KNOW they will be getting an e-mail from us at camp; that not only is the polite thing do but they will then be watching for it so they won’t “trash”” it or put it into the “junk” file of their email program.
NOTICE: SALT IS NOT BEING OFFERED IN 2024.
Date

MM slash DD slash YYYY
Program Selection
- LDP Program – Brookwoods
- LDP Program – Deer Run
- WILD Program – Boys
- WILD Program – Girls
- I’d be interested to be considered for both programs!
What is your first choice if you had a preference?
What is your second choice if you had a preference?
Please note: To be accepted, an applicant must complete this application in its entirety, including medical information and authorization signatures.
Applicant's Name*

First

Last
Applicant's Name as it appears EXACTLY on Passport

First

Middle

Last
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Applicant's E-mail*
Cell Phone*
Permanent Address (If different from above)

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Home Phone
Mother's Name*
Mother's Cell*
Mother's Email*
Father's Name*
Father's Cell*
Father's Email*
Best Emergency Contact*
Phone for Emergency Contact*
Are you a citizen of United States?*
- Yes
- No
What is the country of your citizenship?*
Are you an exchange student*
- Yes
- No
School Name*
Phone
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
School Type*
Current Year in School*
Biographical Information
Birthday*

MM slash DD slash YYYY
Hidden

Start Date of Camp in 2024*

Month

Day

Year
Sex*
- Male
- Female
T-Shirt Size*

Save and Continue Later

Step 1 of 5

Leadership Program Application

Biographical Information

References

Medical Information

Please complete the entire medical section, explaining in detail any pertinent considerations.

School Activity or Organization	9 10 11 12	Leadership Position

Church or Community Organization	9 10 11 12	Leadership Position

Position	9 10 11 12	Hours per week