2024 AALC Camper Registration

2024 AALC Camper Registration

The Awesome Activist Leadership Camp is a fun way for pre-teens and teens, rising 6th graders to rising 11th graders, to become community-engaged leaders making a difference in their community through targeted leadership training and service-learning projects. Rising 12th graders are encouraged to volunteer in leadership roles as junior camp counselors. Rising 12th graders can choose to participate as campers if they do not want to volunteer as a junior camp counselor.

Youth Participant Information
Camper Name*

First NameLast Name
Camper Date of Birth*

MonthDayYear
Date
Camper Age*
Camper Grade Level (the grade you will be entering in the fall of 2024)*
Camper Email *
example@example.com
Camper Phone Number*
Please enter a valid phone number.
What is the name of your school?*
T-Shirt Size*

XSSMLXL2XL3XL4XL

Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*
Please enter a valid phone number.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Does your child have any known medical conditions such as allergies, asthma or medication needs? Please be as specific as possible.*
How did you hear about Awesome Activist Leadership Camp? Please be as specific as possible.*
Terms & Conditions

My child has my permission to fully participate in the Awesome Activist Leadership Camp (AALC) activities. I, as parent/legal guardian, do hereby grant the AALC staff and designated adults the right to authorize emergency medical treatment for my child in the event that I or my designated representative cannot be reached. I agree to hold harmless Awesome Activist Leadership Camp and its agents from liability resulting from an accident.
I hereby grant permission for staff to take whatever steps may be necessary to obtain emergency treatment for my child. These steps may include but are not limited to, the following:
1. In a life-threatening emergency or urgent situation, staff will call 911 before making any attempt to contact parents.
2. For a non-life-threatening emergency, we will attempt to call the parent/guardian first, and if we cannot reach them, we will attempt to contact the emergency contacts listed on the emergency information form. If we cannot make an appropriate contact, we will call the child's health care provider or emergency assistance.
I understand that the AALC and staff will not be responsible for anything that may happen as a result of false information provided by parents/guardians, or as a result of the parent/guardian’s failure to provide information at the time of enrollment. I understand that staff will not administer medication without specific written & signed instruction from the health care provider and/or the child's parent/ guardian.
Enrollment for your child in the Awesome Activist Leadership Camp constitutes your agreement to this waiver.
I understand that all emergency information on the emergency form must be completed before my child may attend camp.
I have read and understand all policy and procedural information, including discipline, health, payment, and cancellation policies.
I agree to the above terms and conditions*

YesNo
Photo/Visual/Audio Image Consent

Awesome Activist Leadership Camp (AALC) will only use student images in a positive manner. We will exclusively showcase students in leadership activities. I grant permission to the Excellence and Advancement Foundation (EAF), its staff, and leadership team, to take and use photo/video/audio images of minor children. Visual/audio images are any type of recording, including but not limited to photographs, digital images, drawing, renderings, voices, sounds, or video recordings. I agree that EAF owns video/audio images and all rights related to them. The audio/video images may be used in any manner or media without notifying me, such as social media websites (Facebook, Instagram, Twitter) under EAF, publications, advertisements, posters. I am aware and consent that my child/children can and/ or will be posting to social media websites while at AALC. I waive the right on behalf of myself, my child to inspect the finished audio/video images or any printed or electronic matter that may be used with them, or to be compensated by them. I also understand that the Excellence and Advancement Foundation is not responsible for any lost or stolen electronics that my child/children may bring to AALC.

I release EAF and its staff, volunteers, and interns, including any firm authorized to publish and/or distribute a finished product containing the audio/video images, from any claims, damages, or liability which I may ever have in connection with the taking of use or images or printed material used with the images.
I agree to the above photo/visual/audio image consent*

YesNo
Refund/Cancellation Policy

Students canceling before Friday, May 31st will be refunded all but a $50.00 processing fee.
Students canceling after Friday, June 7th will be refunded 50% of the registration fee.
A canceled registration fee may be transferred to a student not already registered.
I agree to the above refund/cancellation policy*

YesNo

Payment

My Products

Camper Registration

$150.00 Quantity

Monthly Payment Plan

$25.00 Quantity

Enter coupon

Total

$0.00

If you need payment considerations, please email Daniel Williams dwilliams@breakthepipeline.org.
Payment Methods

Please click one of the PayPal options to complete payment and submit the form.
Should be Empty:

2024 AALC Camper Registration

Youth Participant Information

Parent/Guardian Information

Payment