2025 Legacy Fall Camp Sign Up

1
Full Name* This field is required.Enter name of the young man (ages 12-18) attending.
First Name
Last Name
2
Parent/Guardian Name* This field is required.Enter name of the parent/guardian of young man attending.
First Name
Last Name
3
Parent/Guardian E-mail* This field is required.
4
Phone Number* This field is required.
Area Code
Phone Number
5
Age* This field is required.Enter age of young man attending
6
Do you live in the Phoenix Metro area?* This field is required.
YESNO
7
Any Special Needs or ConcernsLET US KNOW ABOUT ANY SPECIAL CONSIDERATIONS (ALLERGIES, PHOBIAS, OR SPECIAL DIET)
8
Reservation SummaryDetails of the upcoming 2025 L.E.GA.C.Y. Camp
9
How will you complete registration?Please Select Payment Option
Pay With Card
Register with ESA Funds
10
I confirm that I am registering my child using ESA funds.* This field is required.
YESNO
11
ESA Account Holder Full Name * This field is required.(as listed with ESA)
First Name
Last Name
12
ESA Account Email* This field is required.(used for ESA correspondence)
example@example.com
13
ESA Student ID Number (if available)
14
Upload ESA Approval Letter / Screenshot of ESA Portal(Accepted formats: PDF, JPG, PNG)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
15
Registration Dues* This field is required.
prevnext( X )
My Bag
1
My Bag
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
ORDER SUMMARY
Total costUSD
3 Day 2 Night Retreat: Oct 17th - 19th, 2025What’s Included in Your Registration? ✔ 3 days of immersive mentorship, leadership training, and empowerment workshops ✔ Lodging and meals for the duration of the camp ✔ Outdoor and team-building activities ✔ Camp materials and exclusive L.E.G.A.C.Y. Camp gear ✔ A transformative experience that lasts a lifetime!
$300.00Edit
Back
Enter Coupon
Total cost $0.00
First Name
Last Name
16
Invoice ID
Should be Empty: