ALP Enrollment Form
We request that students, not parents, fill out the application. GRADUATED REFUND SCHEDULE: $100 registration deposit is nonrefundable. Cancellations between May 1 and May 31: $675 refunded. Cancellations after May 31: NO refunds made.
Applicant First Name
*
Applicant Last Name
*
Applicant's Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Applicant's Email Address
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Sex
Male
Female
Date of Birth
*
Age (at the time of ALP, see dates below)
*
15
16
17
18
Other (only if already discussed with Director of Outdoor Education)
Current School You Attend
*
Current Year in School
*
Freshman
Sophomore
Junior
Senior
Primary Parent/Guardian First Name
*
Primary Parent/Guardian Last Name
*
Primary Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
ALP has a backpacking and a canoeing option. La Vida cannot guarantee, but will do its best, to place participants in their trip of choice. Please indicate which trip you prefer.
*
Backpacking
Canoeing
I am flexible, either backpacking or canoeing.
Preferred Trip Dates
*
June 27 - July 4
July 11 - July 18
Why are you interested in the Adirondack Leadership Program? Tell us what you know about the program and how you see yourself benefit from this experience.
*
Write a paragraph or more about a leader you want to be like and why. What characteristics do they possess that you want to develop in yourself?
*
What are two leadership qualities you hope to develop more during ALP? Why?
*
ALP includes a faith component that will involve time spent in conversation specifically focusing on your own spiritual and faith development. Tell us a little bit about your desire for your own personal faith development on this trip.
*
Due to the strenuous nature of the activities and remote environment, are there any documented physical, emotional or mental health concerns we need to be aware of?
*
Are you taking any prescribed medications? Please list the medication and reason for taking it.
*
Do you have any allergies or dietary need? Please check all that apply.
*
No Allergies
Celiac (You have been diagnosed as Celiac by a doctor and cannot have any cross-contamination with wheat products)
Gluten-Free (You have a gluten intolerance)
Dairy Free (You have an allergy to milk products)
Lactose-Intolerant (You have an intolerance to lactose)
Peanut Allergy
Tree Nut Allergy
Vegetarian
Vegan
Bee Allergy
Other
If you made a selection above, please explain the allergy and its severity.
Do you carry an EpiPen for your allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)
Yes
No
How did you hear about the Adirondack Leadership Program
*
Prior La Vida experience
Referred by Friend or Family
Online search
Social media
Email
Online ad
Printed ad
Yard sign
Poster
Mailing
Camp fair
Other
I have read and agree to the ALP cancellation policy and graduated fee refund schedule. Please see above for details on the cancellation policy and graduated fee schedule.
*
Yes
No
The above information is true and written by the applicant for the ALP
*
Yes
No
Applicant Name
First Name
Last Name
Submit
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