Camper Details

First Name*

Last Name*

Date of Birth*

Sex*

This information is used for housing assignments.

Entering Grade*

What grade will the applicant be entering in the coming school year?

US Citizenship Status*

Camper's Home Country of Residence*

Family Information

Home Address*

Home City*

Home State/Province*

Home Postal Code*

Home Country*

Parent/Guardian Marital Status*

Session Choice

Camp Program*

Camp Session*

Session One Elective*

Leadership
Aviation
English for Speakers of Other Languages

Session Two Elective*

Leadership
Cybersecurity
English for Speakers of Other Languages

Session One Elective*

Leadership
Cybersecurity
English for Speakers of Other Languages

Session Two Elective*

Leadership
Aviation
English for Speakers of Other Languages

Camper Profile

What goals do you hope your camper will accomplish by attending our camp?*

What camp experience do you expect to most benefit the camper?*

Has the camper experienced any recent life-changing events?*

Please describe any recent life-changing events the camper has experienced.*

Is the camper involved in any pending legal issues?*

Please describe the legal issues in which the camper is involved.*

Has the camper ever been away from home for an extended period of time, or previously attended a residential camp?*

Camper Medical and Behavioral Information

Does the camper have medical, physical, or mental health issues of which we should be aware?*

Please describe the scope of any medical, physical, or mental health issues the camper has experienced and of which we should be aware.*

Has the camper ever engaged in self-harm?*

Please describe the camper's experience with self-harm.*

Has the camper ever been involved with illegal drug use?*

Please describe the camper's experience with illegal drug use.*

Has the camper received any psychological services, counseling, treatment, or assistance?*

Please provide details on the scope of any psychological services, counseling, treatment, or assistance that the camper has received.*

Has the camper evidenced serious discipline or behavior issues at school or in other settings?*

Please describe the camper's disciplinary history.*

Will the camper be taking any prescribed or over-the-counter medications while at camp?*

Please describe the prescription or over-the-counter medications the camper will be taking while at camp.*

Is the camper up-to-date on all vaccinations?*

Due to the California state law that came into effect in June 2016, ALL applicants MUST be fully immunized. This is a requirement. No exceptions will be made. Accepted campers are required to provide official documentation of immunizations from their doctor's office.

Has the camper been exposed to any infectious diseases within the last three months?*

Please describe the infectious diseases to which the camper has been exposed within the last three months.*

Has the camper been out of the country within the past 30 days?*

Please provide the location and duration of travel.*

Does the camper require any special assistance or have any physical limitations or restrictions on activity that cannot be addressed with reasonable accommodation?*

Please explain what activities must be restricted and list any special accommodations required.*

Is there anything you would like to discuss with the camp medical staff?*

Please contact the Academy Health Center staff at 760.547.5213 to discuss your camper's unique medical background.

Parent/Guardian Contact Information

Adult 1 - First Name*

Adult 1 - Last Name*

Adult 1 - Email*

Adult 1 - Primary Phone*

Adult 1 - Relationship*

Adult 2 - First Name

Adult 2 - Last Name

Adult 2 - Email

Adult 2 - Primary Phone

Adult 2 - Relationship

Additional Information

How did you hear about our Summer Leadership Camp?*

Did you speak with a staff member before applying?*

Please provide the name of the staff member you spoke to about the camp.*

Please provide a first or last name.

Financial Responsibility

Please review our camp pricing options here before continuing.

Responsible Party First Name*

Responsible Party Last Name*

Relationship to Camper*

Tuition and Fees*

I have read and completely understand the session pricing outlined at the link above.

Confirmation*

As the applicant's Patron, Guardian, or Representative, I confirm that I agree with the following:

I desire to enter the indicated camper as a participant in Army and Navy Academy's Summer Leadership Camp subject to the Academy's terms of payment and all prevailing rules and regulations. I understand that any misstatement or omission of material information made in this application or during the admission process may result in the revocation of an offer of admission to (or the dismissal of the applicant from) the Academy. I understand that acceptance of this application does not constitute a guarantee of enrollment. The applicant is physically able to perform camp duties as outlined in the Summer Leadership Camp's information systems and communications.

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Summer Leadership Camp Application