a little alaska application form

Application Form

for a little alaska
Hi there, we’re glad you’re interested! If you haven’t already, check out our FAQ page here. Then, if you want, and if registration is open, fill out and submit this application form. When you submit it you'll be directed to a payment page to make your one time $35 non-refundable application fee. You’ll get an email confirming that it was received. Then we'll check it out and get back to you via email within a week.

Don't worry, we only use application information for contacting parents/guardians concerning enrollment, billing or emergencies. We respect your privacy and will NEVER sell or rent your information to ANYONE.

With your permission, we may add your email addresses to our a little alaska list through which we send out occasional updates. If you’d like to remove yourself from that list, it is a simple one-click unsubscribe.

Looking forward to checking out your application!
Participant Information
Name

First NameLast Name
Nickname
Pronouns
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Phone number including country code if outside the U.S.
Cell phone number if the number above is not a cell phone, include country code if outside the U.S.
Email
example@example.com
We may send out a very occasional updates via email to let you know what we're up to.
Date of Birth
We may send out very occasional updates via email to let you know what we're up to. We will never sell or rent your information to anyone. Please let us know if you'd like to hear directly from us a few times a year.
Passport status
Primary Adult Contact Information

This parent or guardian with legal custody is our primary contact for enrollment, billing and emergencies.
Name

First NameLast Name
Daytime phone number including country code if outside the U.S.
Evening phone number including country code if outside the U.S.
Cell phone number including country code if outside the U.S.
Email
example@example.com
Relationship to participant
If your address is different from the participant's address entered above, please complete this section.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Second Adult Contact Information

This adult is our backup contact.
Name

First NameLast Name
Daytime phone number including country code if outside the U.S.
Evening phone number including country code if outside the U.S.
Cell phone number including country code if outside the U.S.
Email
example@example.com
Relationship to participant
If your address is different from the participant's address entered above, please complete this section.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Country
Health and Nutrition
Aside from routine check ups, in the past 24 months have you been under the care of a physician, naturopath, psychologist, psychiatrist or other health practitioner?
Is there any information about your physical or mental health that might have some bearing on this trip?
Are you currently taking any prescribed medication?
Please list all known allergies.
Do you use tobacco?
If you answered yes to any of the questions in the health section, please explain.
Diet
Additional dietary information
Sleeping arrangement preference
Sleeping supervision preference. The bunkhouse is 20 feet from our house.
Participant Questions
Select the term that best describes your teenage education
If you selected other and/or have additional comments please elaborate here
Why do you want to do this?
Tell us a little about yourself. What do you like to do, what do you hope to do if you come stay with us.
Nervous? (totally normal) Questions? (we love 'em) Concerns? (we wanna know) Tell us here.
I am BIPOC and would like a BIPOC scholarship
I would like to apply for the financial assistance scholarship because it is a hardship for me to attend without it.
Please add any explanations to your responses and/or additional information you would like us to know here.
How did you hear about us? Select as many as apply

Other
Thank you for letting us know more about you! When you are ready to apply, please click “Submit.” A copy of your application will be emailed to the participant and primary guardian. We'll be in touch within a week!
I would like to donate to a financial need scholarship. I understand this will be billed with the Program fee.

Other

My Products

Application fee$35.00

Application Fee

Total $0.00

Credit Card

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Application Form

Participant Information

Primary Adult Contact Information

Second Adult Contact Information

Health and Nutrition

Participant Questions

My Products

Credit Card