LTW Leader Registration Form - Male Assigned at Birth

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Thank you for showing interest in being an Outdoor School leader at Waskowitz! We have a limited number of spaces available for Leadership Training Weekend and need to fill all weeks of Outdoor School with leaders. With these parameters in mind, we will be assigning high school leaders to requested weeks on a first-come, first-served basis. A Waskowitz staff member will email you to confirm your placement.

Email *

Student Name *

Birth date *

YYYY

School *

Grade *

9th

10th

11th

12th

Gender Assigned at Birth

Male

Female

Clear selection

Preferred Pronouns

Name of Parent/Guardian *

Home Address *

Emergency contact Phone *

Student email *

Student phone number *

Best way to get in touch *

Call

Text

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