Summer 2026 Camp Fast Forward: Participant Application

This is a FREE one-week summer camp for students entering grades 8 or 9 in the summer of 2026. Students will earn CPR certification and hands-on experience in a variety of health care professions. Students must participate in all camp dates and must have transportation to and from the program site daily. This is a two-part application process. Students will have the option to select their "preferred" site when completing the application. This project is funded by a Future of HealthC.A.R.E. Program Grant from The Rapides Foundation. Through its Future of HealthC.A.R.E. (Career, Academic Readiness and Exploration for Students) Program Grant, the Foundation seeks to increase the number of qualified Central Louisiana students enrolling in healthcare training programs or entering into the healthcare workforce.
Student Applicant Information

Please complete all questions below:
Did you participate in the "Camp Fast Forward" program last summer?
Home Parish:
Which parish does the student applicant currently reside in?
Student Applicant Name

First NameLast Name
Student Applicant Date of Birth

MonthDayYear
Date
Student Applicant Gender:
Preferred Phone Number
Please enter a valid phone number. Central LA AHEC may use this number to send out program reminders. Please make certain that you have access to this phone number and you are able to receive text messages.Format: (000) 000-0000.
Preferred Email
DO NOT USE a school or state email as this sometimes is rejected by the email server. All communication concerning this program will come via email. Please make certain that you have access to this email account.
Name of School currently attending:
Current school grade level?
Name of School entering in Fall of Academic Year 2025-26:
What grade will student applicant be entering in the 2025-26 academic year?
Student Applicant Ethnicity / Race:

Other
This program requires that the student have daily transportation to and from the camp site. Although this is not guaranteed, which site is preferred:

Other
Did my child participate in the MedStart program at his/her school during this school year? This year, this program was only offered at the following schools: Avoyelles Public Charter, Marksville High, LaSAS, Block High School, Harrisonburg High School, Grant Jr. High, Georgetown High School, Fellowship Elementary, LaSalle Jr. High, Alexandria Middle Magnet School, Brame Middle School, Buckeye High School, Arthur F. Smith, Poland Jr. High, Leesville Jr. High, Pickering High School, Calvin High School, Dodson High School, and Winnfield Jr. High.
Funding for this program is provided by The Rapides Foundation. I understand that if my child is selected to participate in this summer camp, my child must attend ALL camp days. Failure to attend all camp days could disqualify my child from future Central Louisiana AHEC program opportunities.
Transportation for this program is not available. Do you have reliable transportation to and from the camp site each day?
Student Applicant T-Shirt Size:
Student Applicant Career of Interest:
Please list up to 3 careers that student is potentially interested in.
Student Applicant Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Applicant Mailing Address

Address

Address Line 2

CityState / Province

Postal / Zip Code
Student Applicant Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Guardian Contact Information
Mother/Legal Guardian Name and Relationship

Full NameRelationship to Student Applicant
Mother/Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother/Legal Guardian Email
example@example.com
Father/Legal Guardian Name and Relationship

Full NameRelationship to Student Applicant
Father/Legal Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father/Legal Guardian Email
example@example.com
Emergency Contact Information
Emergency Contact Name and Relationship

Full Name Relationship to Student
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Applicant Health Information
Please list all medical conditions, if any, for the Student Applicant:
If none, please put N/A
Please list all allergies, if any, for the Student Applicant:
If none, please put N/A
Physician Name

First NameLast Name
Physician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please upload a copy of the FRONT of the student applicant health insurance card. If your child doesn't have health insurance, please upload a blank image or document.

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Please upload a copy of the BACK of the student applicant health insurance card. If your child doesn't have health insurance, please upload a blank image or document.

Cancelof
Please upload your current report card.

Cancelof
Please upload your completed student assessment provided to you by a school faculty member.

Cancelof
Signature
Date

MonthDayYear
Date
Should be Empty:

Student Applicant Information

Guardian Contact Information

Emergency Contact Information

Student Applicant Health Information