Leadership Camper Application

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Email *

What is your first name? *

What is your last name? *

Which program are you applying for? *

LC (must have completed sophomore year by the start of the program)

LIT (must have completed junior year by the start of the program)

What are your pronouns? *

She/her

He/him

They/them

Other:

Which camp best reflects your gender identity? *

Girls+

Boys+

What CT will you earn this summer? (Enter 1 if first year) *

What sessions can you attend camp this summer? *

Session 1

Session 2

Session 3

Session 4

Required

Please list your session preferences in order of preference (for example: 3,4,2) excluding those you cannot attend. *

What are your reasons for wanting to return to Camp Takodah this summer? What do you hope to gain from the experience?
*

Why are you interested in joining the Leadership Program? What do you hope to gain from the experience?
*

What traits or experience do you have that will contribute to your success this summer?
*

Please acknowledge the following by typing your name after reading this.

STATEMENT OF AGREEMENT

Camp Takodah strives to provide a successful camping experience for every camper. I agree to inform Camp Takodah of any disabilities, medical conditions, and/or behavioral issues affecting the applicant to ensure that accommodations are available.

I have read and agreed to the entire LC Application Packet, including the Personnel Policies. I agree to comply with the Camp Takodah leadership team toward the positive resolution of any challenges regarding the applicant. I understand that in some cases, this may result in the dismissal of a LC participant from the camp program.

I understand that the LC Program is competitive, which means that some applicants might not be accepted into the program. If an applicant is not accepted into the LC Program, all fees will be refunded. I also understand that the LC Program does not guarantee acceptance into the LIT Program at Camp Takodah. The LIT Program is very competitive, and some LC Graduates might not be accepted into the program.

I attest that the applicant may participate in all camp activities, except as noted on the Health History & Examination Form. I give permission to Camp Takodah to transport the applicant to/from camp for field trips and medical treatment.

I understand that the registration deposit is not refundable after February 1. All other tuition payments are refundable until May 31. There are no refunds after June 1 for any reason. No refunds or adjustments are made for campers who arrive late, depart early, or are dismissed from the program.

I authorize the Cheshire YMCA to use photos, videos, or likenesses of the applicant taken in the YMCA’s camping program for business and promotional purposes. I understand that the applicant's name will appear on the camp address list.

HEALTH AND ACCIDENT DISCLAIMER FOR PARENT/GUARDIAN ATTENTION: The Takodah YMCA does not carry any form of accident/illness or dismemberment insurance on any camper. It is the YMCA’s position that each camper’s health, medical care, and medications are the responsibility of the respective parents. For all medical care, parents will be invoiced directly or the cost will be added to the camper’s store account.

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