Legacy Youth Academy | Summer 2022 Lead & Inspire Enrichment Program Application

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Please complete the questions below to apply for admission to the Legacy Youth Academy Summer 2022 Lead & Inspire Enrichment Program. If you are interested in applying for admission for more than one child, please complete a separate application. Upon submission of the application, you will be notified on or before Friday, June 3rd, 2022, of the application status.

If you have any questions, please contact Legacy Youth Academy at 380-213-3189 or email ajohnson@wearelegacyu.com.

Child's Information

Name *

First and last name

Nickname

Date of Birth *

YYYY

Age (eligible campers must be between ages 11-17) *

School *

Grade in Fall 2022 *

T-Shirt Size *

XXL

Other:

Has camper attended this camp before, or one like this? *

Yes

Other:

Is camper ok to travel to Atlanta, GA for HBCU tour? *

Yes

Other:

What are some of camper's hobbies? *

What is the camper most looking forward to at camp? *

Parent/Guardian Information

Name *

Address (including city, state) *

Address Zip Code *

Relationship to Child *

Phone Number *

Email Address *

Emergency Contact Information

Name *

Relationship to Child *

Phone Number *

How did you hear about us?

Social Media (e.g. Instagram, Facebook, etc.)

City of Columbus

Personal Referral

Other

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