2021 Lone Star Leadership Academy New Student Application

2021 Lone Star Leadership Academy Student Application
Section 1: Preliminary Information
Before beginning, make sure you have the following information:
- Contact information for all parents/guardians and an emergency contact
- Your child's t-shirt size
- A copy or picture of your child's most recent report card (can be submitted separately)
- A copy or picture of the front and back of your child's health insurance ID card (can be submitted separately)
- Credit/Debit card or checking account and routing numbers
Has your student previously attended a Lone Star Leadership Academy program? *

No Yes

Welcome Back!

Please click the link below to use the Returning Student Application. It's shorter!

www.educationinaction.org/alumni-application

Has an educator already nominated your child for the Lone Star Leadership Academy? *

Yes No
Are you applying for either a Donated Lone Star Leadership Academy Scholarship or the Group Discount? *

Yes No

Section 2: General Contact Information
Student
Name *

First Name Last Name
Gender *

Male Female
Mailing Address *

Street Address

Street Address Line 2

City State

Zip Code
Parent/Guardian 1
Name *

First Name Last Name
Relationship to Student *
Primary Phone Number *
Alternate Phone Number
Primary Email Address *

Confirmation Email
Alternate Email Address

Confirmation Email
Parent/Guardian 2
Name

First Name Last Name
Relationship to Student
Primary Phone Number
Alternate Phone Number
Primary Email Address

Confirmation Email
Alternate Email Address

Confirmation Email
Emergency Contact

This should be someone other than a parent or guardian.
Name *

First Name Last Name
Relationship to Student *
Primary Phone Number *
Alternate Phone Number
Consent to Release Information
May we release your contact information (phone, email) to other parents in your area who are interested in carpooling? *

Yes No
May we include your child in a student directory which will be provided ONLY to the other students in his/her camp session? (The directory contains student names, mailing addresses, and one student email address.) *

Yes No
Student Email Address for Directory:

Confirmation Email

Section 3: Academic Information
School

Please provide the following information based on the 2020-2021 school year.
Grade Level *
School Name *
School District *
For private or charter schools, enter "private" or "charter."
Grade Average Verification

Please note that applications will not be processed until grade average verification is complete. Report cards must indicate a B/85 or higher overall grade average and a "satisfactory" or equivalent conduct grade. Students with a conduct grade below "satisfactory" or equivalent will be asked to provide an additional letter of recommendation from an educator.
Please choose one option for submitting your child's most recent report card. *

Upload now Email, fax, or mail separately
Upload your child's most recent grade report here. *

Browse Files

Cancel of
PLEASE NOTE

Your application will not be processed until we have received
your child's report card.
School/Community Activities

Please list two recent school/community activities. These are anything your child participates in outside of regular classroom instruction. Examples include participation in sports teams, scouting, after-school clubs, volunteer work, music lessons, dance classes, tutoring other students, church activities, contests, etc. You may also include recent awards or honors, excluding Honor Roll.
1. *
2. *

Section 4: Select a Camp Session

Final placement will be confirmed via email. After May 15, 2021, a $65 administrative fee will be required to change camp sessions.
Select Location

Lone Star Leadership Academies are best experienced in the following order: Dallas/Fort Worth, Austin/San Antonio, then Houston/Galveston. Education in Action recommends that all 4th, 5th, and 6th graders sign up for the Dallas/Fort Worth program first so that in the future they will be able to participate in all Lone Star Leadership Academy programs should they desire to do so.
Choose camp location (4th grade): *

Dallas/Fort Worth (4th, 5th & 6th Graders)
Choose camp location (5th grade): *

Dallas/Fort Worth (4th, 5th & 6th Graders) Austin/San Antonio (5th, 6th & 7th Graders)
Choose camp location (6th grade): *

Dallas/Fort Worth (4th, 5th & 6th Graders) Austin/San Antonio (5th, 6th & 7th Graders) Houston/Galveston (6th, 7th & 8th Graders)
Choose camp location: (7th grade) *

Austin/San Antonio (5th, 6th & 7th Graders) Houston/Galveston (6th, 7th & 8th Graders)
Choose camp location: (8th grade) *

Houston/Galveston (6th, 7th & 8th Graders)
Location
Program Location
Select Week
Please select your top three preferred camp sessions below. You have the option to list "none" as your second and/or third choice, but please note that selecting only one camp session does not increase the likelihood that you will be placed in that session. Your first choice will be honored if space is available, but providing a second and/or third choice will expedite the processing of your application should your first-choice session be unavailable. Your final placement will be confirmed via email.
1st Dallas/Fort Worth Choice: *
Your first choice will be honored if space is available.
2nd Dallas/Fort Worth Choice: *
Selecting a second choice will expedite the processing of your application should your first choice be unavailable.
3rd Dallas/Fort Worth Choice: *
Selecting a third choice will expedite the processing of your application should your other choices be unavailable.
1st Austin/San Antonio Choice: *
Your first choice will be honored as long as space is available.
2nd Austin/San Antonio Choice: *
Selecting a second choice will expedite the processing of your application should your first choice be unavailable.
3rd Austin/San Antonio Choice: *
Selecting a third choice will expedite the processing of your application should your other choices be unavailable.
1st Houston/Galveston Choice: *
Your first choice will be honored as long as space is available.
2nd Houston/Galveston Choice: *
Selecting a second choice will expedite the processing of your application should your first choice be unavailable.
3rd Houston/Galveston Choice: *
Selecting a third choice will expedite the processing of your application should your other choices be unavailable.
1st Choice
2nd Choice
3rd Choice

Section 6: Additional Information
T-Shirt Size: *
Sandwich Choice for One Meal: *
Will your student require all meals to be vegetarian? *
How did you hear about the Lone Star Leadership Academy? *

Section 7: Refund and Fees Policy
The completed application must be submitted no later than the Application Deadline or Late Application Deadline and include credit card/debit card payment or a check or money order made payable to Education in Action. If a payment is denied, the postmark date of the payment sent will be voided. For example, if a payment is postmarked by May 15, 2021 but the payment is denied, the $45 late fee will be assessed and the remaining balance will be due 15 calendar days prior to the student’s camp session start date. If the $300.00 non-refundable deposit has been paid and the application processed, the deposit amount will not be refunded. After receiving a welcome packet, a $5.00 replacement fee will be required to obtain another copy.

Student and Parent/Legal Guardian should note that if, after Education in Action has accepted the student’s application, the Parent/Legal Guardian cancels the student’s participation in the Lone Star Leadership Academy, a refund of the tuition already paid minus the $300.00 deposit will be issued provided that notification of cancellation and request for refund is received in writing by Education in Action no later than May 15, 2021. No refund will be made for tuition or charter bus transportation if the notice of cancellation (including the cancellation of transportation only) is received after May 15, 2021; this includes, but is not limited to, cancellation due to illness/injury, inclement weather, and/or lack of transportation. All sponsorship payments must be postmarked to Education in Action no later than 15 calendar days prior to the student’s camp session start date in order to receive reimbursement; no reimbursements for sponsorships will be issued for payments postmarked within 15 calendar days of the student's camp session start date.

Student and Parent/Legal Guardian should note that all applications are processed strictly in order of receipt and that applications may exceed available space. This is an application for participation and enrollment is contingent on final approval by Education in Action, with whom sole discretion resides. If the application is denied, the application and all monies included will be returned. Education in Action reserves the right to cancel a program before the student’s departure from home, in which case any monies paid to Education in Action will be refunded. Education in Action reserves the right to change or modify a program's itinerary before or after a program is scheduled to begin.

Student and Parent/Legal Guardian should note that requests to add charter bus transportation must be provided to Education in Action in writing and must be submitted with the $80.00 transportation fee no later than 15 calendar days prior to the student's camp session start date.

Student and Parent/Legal Guardian should note that if, after Education in Action has accepted the student’s application, Parent/Legal Guardian changes the student's scheduled camp session for any reason, a $65.00 administrative fee will be charged if the change occurs after May 15, 2021. Camp session changes may be requested up until two Fridays (nine calendar days) prior to the originally scheduled camp session start date and will be honored on a space available basis. Camp session change requests must be provided to Education in Action in writing and must be submitted with the $65.00 payment (if applicable based on date).

In the event that a program must be rescheduled for any of the following causes: Acts of God or public enemies, civil war, insurrection or riot, fire, flood, explosion, earthquake, serious accident, public health risk, strike, labor dispute, or any cause beyond Education in Action’s reasonable control, the above cancellation policy remains in effect with the exception that the non-refundable deposit will remain on the student’s account for a future program. If the student does not enroll in a future program, the deposit remains non-refundable.
Parent/Guardian Signature: *

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Student Signature: *

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Section 8: Emergency Medical Authorization
I do hereby request, authorize, and give permission to Education in Action, or its duly authorized representative, to act on my behalf and in my stead, should my son/daughter complain of being ill, be injured, or require emergency or other medical treatment, including hospitalization, during the Lone Star Leadership Academy. I understand that in the event that my son/daughter complains of being ill, or is injured during the Lone Star Leadership Academy, he/she will be taken to a hospital emergency room and examined by an emergency room physician. If the physician determines that my son/daughter does not require hospitalization but should not continue as a program participant, at the written direction of the physician, my son/daughter will be sent home promptly. I expressly stipulate and agree that I will be solely responsible for all expenses incurred and will release and hold harmless Education in Action, its officers, directors, employees, administrators, agents, successors, and assigns from all claims, demands, damages, actions, or causes of action, present or future, whether known, anticipated or unanticipated, and resulting from, rising out of, or incident to Education in Action’s actions pursuant to this authorization.

I understand that I will be required to pick up my child in a timely manner in the event that he/she becomes injured or ill and is unable to continue participation in the Lone Star Leadership Academy.
Parent/Guardian Signature: *

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Section 9: Release and Agreement to Program Rules
The program participant and Parent/Legal Guardian agree to the following terms:

In consideration of being accepted as a participant in the Lone Star Leadership Academy, the undersigned Student and undersigned Parent/ Legal Guardian each hereby release and hold harmless Education in Action and its employees and agents from any liability arising out of my participation in said program, and each further agrees to reimburse Education in Action or its employees and agents for any loss, damage, or costs they may incur during said program and that are caused by my participation. Education in Action shall not be liable or responsible for any injury, loss, damage, or delay resulting from any act or neglect of any person or company whose services are retained by Education in Action for the benefit of program participants, including but not limited to, accommodations, restaurants, or transportation companies. Furthermore, Education in Action cannot be held responsible for any act, error, or omission on the part of any program participant or participants.

I understand that the Lone Star Leadership Academy is a professional program and as such demands the highest standards of behavior. I will conduct myself in a manner that will contribute to a sense of community among all participants and foster an atmosphere of mutual respect. Any student possessing or using drugs or alcohol, violating curfew, leaving the activities of the program, or behaving in any manner inconsistent with Education in Action standards or local, state, or federal statutes will be immediately dismissed from the program. Education in Action follows a zero tolerance policy; there are no second chances. If a student is dismissed from the program for disciplinary reasons or upon advice of a medical doctor, the student’s Parent/Legal Guardian will assume all financial responsibility for returning the student home. No tuition refund will be made.

I agree my participation entitles me to the standard arrangements and activities offered and/or scheduled by Education in Action, including, but not limited to, housing, meals, charter bus transportation during the program, and educational materials, and that all special arrangements and/or requirements must be independently provided and/or that I must bear the cost of any and all special arrangements and/or requirements outside of the standard activities and arrangements offered by Education in Action.

For the health and safety of every participating student, Education in Action reserves the right during the entire program to conduct dormitory inspections to ensure student compliance with the stated rules and regulations. While student phone calls are not scheduled throughout the program, parent updates will be provided on Education in Action’s website during the program week. Cell phones and other electronic devices (i.e. Apple watches, iPods, gaming devices, alarm clocks, laser pointers etc.) are not permitted on the program. This includes the use of cell phones for the sole purpose of taking photos. Digital cameras are permitted.

Education in Action reserves the right to use, in any or all publications, promotional materials and publicity, basic student information (e.g. name, school, hometown) and further reserves the right to use in all publications, promotional materials, and publicity any photograph, audiotape, videotape, or film in which the student may appear.
Parent/Guardian Signature: *

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Student Signature: *

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Section 10: Authorization
Each of the undersigned has carefully read the complete application including the Refund and Fees Policy, Emergency Medical Authorization, and Release and Agreement to Program Rules (including the cell phone and electronics policy), and with full understanding of the terms and refund policy, consents to the participation of the undersigned student in accordance with the standards, rules, and regulations of Education in Action.
Parent/Guardian Signature: *

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Student Signature: *

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Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Please Submit a Paper Application
We are currently unable to accept online applications for students who have not been nominated by an educator, or who are applying for either the Donated Lone Star Leadership Academy scholarship or the Group Discount. Please submit a paper application, available here.

If you have any questions, please contact us at 817-562-4957 (menu option 3) or admissions@educationinaction.org.

Thank you! We look forward to receiving your application!
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2021 Lone Star Leadership Academy Student Application

Section 1: Preliminary Information

Section 2: General Contact Information

Student

Parent/Guardian 1

Parent/Guardian 2

Emergency Contact

Consent to Release Information

Section 3: Academic Information

School

Grade Average Verification

School/Community Activities

Section 4: Select a Camp Session

Select Location

Select Week

Section 5: Medical Information

Temporary Insurance Information

Acknowledgement

Medical Insurance

Student Health Information

Section 6: Additional Information

Section 7: Refund and Fees Policy

Section 8: Emergency Medical Authorization

Section 9: Release and Agreement to Program Rules

Section 10: Authorization

Section 11: Tuition and Deadlines

Tuition

Optional Items

Please Submit a Paper Application