2024 LSLA Alumni Information Update without Date Selection

Does your student have health insurance?*

YesNo

Health insurance is required for participation in the Lone Star Leadership Academy. If your student does not currently have medical insurance, Education in Action can provide you with information about short-term travel insurance. If you are not able to complete the acknowledgement below, please call our office at 817-562-4957 ext. 104 before proceding.

LONE STAR LEADERSHIP ACADEMY

HEALTH INSURANCE ACKNOWLEDGEMENT

Education in Action requires all Lone Star Leadership Academy participants to have health insurance for the duration of their program.

Education in Action will provide information about a low-cost travel insurance plan which provides emergency medical coverage during the program and meets the requirements of the Lone Star Leadership Academy. You are also welcome to find your own source of coverage.

Education in Action will email you approximately four weeks prior to the start of your student's camp with instructions for purchasing the travel insurance plan or providing proof of coverage through another source.

I understand that my student cannot attend the Lone Star Leadership Academy without proof of health insurance.*

Parent/Legal Guardian's Initials

I understand that it is my responsibility to ensure that my student has health insurance during his/her camp attendance.*

Parent/Legal Guardian's Initials

I understand that I must provide Education in Action with proof of health insurance coverage no later than one week prior to the start of my student's program.*

Parent/Legal Guardian's Initials

I understand that my student will not be allowed to attend his/her program without proof of health insurance coverage.*

Parent/Legal Guardian's Initials

Please upload a copy of the front and back of your student's current health insurance ID card:*

Browse Files

Are your student's state-mandated vaccines up-to-date?*

YesNo

Please explain:*

Does your student have any allergies we should be aware of (other than seasonal allergies)?*

YesNo

Will your student bring an EpiPen to camp?*

YesNo

Please describe your student's allergies in detail (what he/she is allergic to, level of severity, student's level of independence in managing the allergy, etc.).*

Does your student have asthma?*

YesNo

Will your student bring an inhaler to camp?*

YesNo

Please describe your student's asthma in detail (what triggers his/her asthma, level of severity, student's level of independence in managing his/her asthma, etc.).*

Does your student have any special dietary needs?*

YesNo

Please describe:*

Does your student have a physical disability, hearing impairment, or vision impairment that will require special assistance or arrangements?*

YesNo

Please describe:*

Is there any other reason your student may require special assistance or arrangements, or is there anything else the camp staff should be aware of?*

YesNo

Please describe:*

Student and Parent/Legal Guardian should note that a fee of $60.00 will be assessed if the student has not been picked up within 15 minutes of the published pick-up time on the final day of the program.

Please initial to confirm that you understand the late pick-up fee: Initials*

In order to present a more professional and polished appearance while meeting with speakers and visiting venues, the Lone Star Leadership Academy has adopted a new dress code for all participants and staff beginning in in the summer of 2023.

Updates include:
·        All shorts, skirts, and pants must be solid-color garments in khaki or navy (except on Sunday)
·        Students may not wear denim (except on Sunday)
·        Students may not wear Crocs (except on Sunday and in the shower)

Students may still wear casual attire appropriate for travel on Sunday, and will still receive a t-shirt to wear each day beginning on Monday.

The full dress code is available to view online at https://educationinaction.org/lone-star-leadership-academy/dress-code. You will also find a list of resources for affordable shorts/skirts/pants.

Please initial to confirm that you have reviewed the updated dress code: Initials*

Update Student Information

Section 1: Update Contact Information

Student

Parent/Guardian(s)

Parent/Guardian 1

Parent/Guardian 2

Additional Emergency Contact

Consent to Release Information

Section 2: Update Academic Information

Section 3: Update Health Information

Temporary Insurance Information

Acknowledgement

Health Insurance

Student Health Information

Policy Updates

Addition to Refund and Fees Policy

Updated Dress Code