Teen Leadership Application

Pacifica's Outdoor School Student Leader Application
Si necesitas este formulario en español, selecciona 'Español' en la parte superior derecha de esta página.

Pacifica's Outdoor School (PODS) Student Leadership Program gets high school students outside and mentoring fifth and sixth graders at Outdoor School.

Student leaders are expected to participate in two In-Person Leadership Training days and assist in facilitating at least one 3-day/2-night session of Outdoor School. The program includes leadership training, outdoor education, lodging, transportation, meals, and lots of fun.

We are committed to being an accessible program. If you need this form in a written format or another language, please email education@pacificagarden.org
Student Leader Information
Name of High School you attend*
If you selected "other", please write in your school name
Student Full Name*
Legal First & Last Name
Preferred Name *
Pronouns
If your legal name and preferred name do not match, what name and pronouns do you want us to use in communication with your parents/guardians?

Name you prefer for communication with parentsPronouns
Your Primary Email*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Birth Date*

MonthDayYear
Grade*
Expected Graduation Year
How did you hear about the Student Leadership Program?*
If a friend referred you, please type their name here, they will enter a raffle to win a prize.
Let us know your leadership experience and/or what you want to learn and tell us why you are excited to participate.....*
Do you need transportation provided to attend outdoor school events?

Yes, I will need transportation provided to attend outdoor school events at PacificaNo, I can provide my own transportation to and from outdoor school events at Pacifica
Parent/Guardian Information

This is information so we can contact your parent/guardian(s) to have them complete the parent guardian waiver or in case of emergency.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Parent/Guardian E-mail*

Confirmation Emailyour parents email: example@example.com
My Parent/Guardian will need forms provided in*

EnglishSpanishOther
Communication
Please choose the form of communication you prefer.
Student Behavior Agreement
Pacifica's Outdoor School is a school in the outdoors, and the rules at your regular school apply while you are at Pacifica. It is important for students to remember that in order to learn and have fun, each student is responsible for demonstrating appropriate behavior.

Students will be expected to:
- Use behavior that supports learning during field study times.
- Listen to and follow instructions.
- Cooperate and participate in activities.
- Respect the rights of others to participate and learn.
- Get along with adults, student leaders, and other students.
- Cooperate with all students and staff.
- Respect nature.
- Use appropriate language. No Swearing!
- Follow the Outdoor School rules for behavior and safety.
Unacceptable behaviors include:
- Swearing
- Refusing to follow instructions or directions.
- Bullying, pushing, shoving, or intimidating other students.
- Behaving stubbornly toward staff.
- Play fighting or engaging in physical horseplay.
- Disrupting Outdoor School activities.
- Refusing to participate in Outdoor School activities.
Behaviors that threaten the safety of students or staff, or put anyone at risk, will result in a student being sent home and may lead to further consequences. These behaviors include:
- Violent acts against staff or students.
- Theft or vandalism.
- Possession of alcohol, tobacco products, narcotics, or dangerous drugs.
- Possession of a weapon.
- Engaging in overt sexual behavior toward students or staff, or running away from supervisors.
Any search of personal belongings will be conducted in accordance with the school district’s student search and discipline protocol.

Student Leader understand that their primary responsability is to be a positive role model for students.
Writing your full name acts as your signature*

First NameLast Name
Date*

MonthDayYear
Should be Empty:

Pacifica's Outdoor School Student Leader Application

Student Leader Information

Parent/Guardian Information

Communication

Student Behavior Agreement