Southwest Key Leader 2023 Registration

This program teaches skills essential for students to become values-driven leaders. Students learn to connect with students from different backgrounds and experience what it means to be a team player. They learn that working together is the key to successfully completing important projects and that real leaders put others first.

This is an opportunity to make lifetime friends with people who share their integrity and values.

Since 2005 more than 33,000 students around the world have participated in Key Leader Weekends.
- DATES: November 10-12, 2023
- ADDRESS: Kamp Kiwanis, 20 Cousin Road, Vanderwagen, NM 87326 (20 miles South of Gallup)
The cost for students is $175 if registered and paid in full by October 1, 2023, and $200 after. Costs for adults is $150.

Participation in Key Leader is limited. Registrations received after the participant limit is reached will be added to a waitlist.

Event Contact:Kathi Tran at (408) 674-4298 or KTran@SWDKiwanis.org.
Participant's First Name*
Participant's Last Name*
8th GradeFreshmanSophomoreJuniorSeniorN/A - Adult
Participant's Birthdate*

MonthDayYear
Participant's School (type "Adult" if you're a chaperon)*
YesNoI am a KiwanianI am an SLP Faculty AdvisorI am Kamp Kiwanis Staff
Participant's Mailing Street Address*
(Just enter the street address here..."123 Main Street"...the City, State and Zip come next)
Participant's City*
Participant's State*
Participant's Zip Code*
Best Phone Number to Reach Participant*
Best Email Address to Reach Participant*
Now that we have the preliminaries out of the way, let's get some information that will help us plan for the event!
YesNo
Participant's T-Shirt Size (all shirts are adult unisex)*
FemaleMalePlease contact me to discuss
YesNo
If "Yes" please explain:
Please list any medications the participant will be taking with at Key Leader:
NoYes
If "Yes", please explain:
No restrictionsVegitarianVeganKosherHalalGluten FreeOther
Participant's Emergency Contact
Emergency Contact Name*
Emergency Contact Phone Number*
Emergency Contact Relationship*
Transportation

The site of Key Leader, Kamp Kiwanis, is located 20-miles South of Gallup, New Mexico. Kamp Kiwanis is 5 1/2 hours from Phoenix, 6 1/2 hours from El Paso, and just under 3-hours from Albuquerque.
My family will drive meI am coming with an adult chaperone (adult chaperones must register)I would be interested in carpooling
AlbuquerqueEl Paso/Las CrucesPhoenixTucson
Disclosures:
All participants must read and acknowledge their acceptance of the Key Leader Community Values Contract before finalizing their registration. A completed contract must be brought with you to Kamp along with a signed Covid Release, Medical Release and Kamp Kiwanis Release. All forms will be available on the event page at SWDKFoundation.org/key-leader, as well as emailed to all registered attendees prior to the start of the event.*

I understand
I understand
I understand
I understand
Payment
Student Attendee ($175 is registrered and paid in full by 10/1/23 and $200 if not)Adult Chaperone ($150)Kamp Kiwanis Staff
There are two options for paying for Key Leader registrations:

To Pay by Check: You can mail a check made payable to "SW District Kiwanis Foundation" to:

Jim Sowers, Treasurer
SW District Kiwanis Foundation
5318 Kings Row NE
Albuquerque, NM 87109

To Pay by Credit Card: If you prefer to pay by credit card, we can send you an invoice with a link to pay by credit card.
CheckPlease send me an invoice to pay by credit card
Sponsors

A "sponsor" is someone who pays for you to attend Key Leader. Your sponsor might be paying all of your registration or a portion of your registration. A sponsor may be a local Kiwanis Club, Kiwanian or a business.
YesNo
If "Yes" please complete the following:
Name of Sponsor:
All of my registrationA portion of my registrationI do not know
Email address of Sponsor:
Phone number of Sponsor:
Parent/Guardian Contact Info

If you are a student, we're going to need the name and contact information for at least one of your parents/guardians. (If you are an adult, please type "n/a")
Parent/Guardian Name*
Parent/Guardian Email Address*
Parent/Guardian Mailing Address*
Student Facilitators

If you’re a Key Leader Graduate and entering the 11th or 12th grade (underclassman may apply with special circumstances), you can apply to be a Student Facilitator. Student Facilitators play an important role in the program and therefore have more work and responsibilities. Student Facilitators must be able to arrive at Kamp Kiwanis by 2pm on Friday, Nov. 10th to receive training. There are only a few Student Facilitator spots available and all applications are subject to review prior to camp. A confirmation email accepting you as a Student Facilitator will be sent 2 weeks prior to camp. If not selected, you may still attend camp as a participant.
YesNo
For Adult Chaperones:

Adults aged 21 and older may apply to be an Adult Chaperone at Key Leader. This requires the adult to be an active adult participant throughout the weekend. Adults must adhere to the same code of conduct and requirements as the students and are asked to not leave the camp site during the weekend.
I have a current Kiwanis-provided background check on file.I do not have a current Kiwanis background check on file, but will work with event coordinators to obtain the screening prior to the event. I understand if the screening is not completed by the time of the event I will not be permitted to attend and may forfeit my registration fee.
Should be Empty:

Now that we have the preliminaries out of the way, let's get some information that will help us plan for the event!

Participant's Emergency Contact

Transportation

Disclosures:

Payment

Sponsors

If "Yes" please complete the following:

Parent/Guardian Contact Info

Student Facilitators

For Adult Chaperones: