Summer Leadership Camp Application Camper DetailsFirst Name* Last Name* Date of Birth* MM slash DD slash YYYY Sex*--Select--MaleFemaleThis information is used for housing assignments.Entering Grade*--Select--789101112What grade will the applicant be entering in the coming school year?US Citizenship Status*--Select--US CitizenNon-US CitizenGreen Card HolderCamper's Home Country of Residence*--Select--United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweFamily InformationHome Address* Home City* Home State/Province* Home Postal Code* Home Country*--Select--United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweParent/Guardian Marital Status*--Select--MarriedSingleSeparatedDivorcedSession ChoiceCamp Program*--Select--Middle School Leadership CampHigh School Leadership CampCamp Session*--Select--2-Week Session One (6/27 - 7/9)2-Week Session Two (7/11 - 7/23)4-Week Dual Elective Session (6/27 - 7/23)4-Week Leadership Education Session (6/27 - 7/23)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 ProfileWhat 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?*--Select--NoYesPlease describe any recent life-changing events the camper has experienced.*Is the camper involved in any pending legal issues?*--Select--NoYesPlease 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?*--Select--NoYesCamper Medical and Behavioral InformationDoes the camper have medical, physical, or mental health issues of which we should be aware?*--Select--NoYesPlease 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?*--Select--NoYesPlease describe the camper's experience with self-harm.*Has the camper ever been involved with illegal drug use?*--Select--NoYesPlease describe the camper's experience with illegal drug use.*Has the camper received any psychological services, counseling, treatment, or assistance?*--Select--NoYesPlease 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?*--Select--NoYesPlease describe the camper's disciplinary history.*Will the camper be taking any prescribed or over-the-counter medications while at camp?*--Select--NoYesPlease 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?*--Select--YesNoDue 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?*--Select--NoYesPlease 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?*--Select--NoYesPlease 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?*--Select--NoYesPlease 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?*--Select--NoYesPlease contact the Academy Health Center staff at 760.547.5213 to discuss your camper's unique medical background.Parent/Guardian Contact InformationAdult 1 - First Name* Adult 1 - Last Name* Adult 1 - Email* Adult 1 - Primary Phone*Adult 1 - Relationship*--Select--Parent - MotherParent - FatherLegal GuardianGrandparentAuntUncleOther Family MemberOtherAdult 2 - First Name Adult 2 - Last Name Adult 2 - Email Adult 2 - Primary PhoneAdult 2 - Relationship--Select--Parent - MotherParent - FatherLegal GuardianGrandparentAuntUncleOther Family MemberOtherAdditional InformationHow did you hear about our Summer Leadership Camp?*--Select--AlumnusAMCSUSBingBoarding School ReviewCamp FairCounselor or TherapistCurrent CadetCurrent SchoolFacebookFriendGoogleIECA Educational ConsultantInstagramInternational AgentLearning SpecialistLinkedInLocal NewspaperLocal ResidentNew York Times ProfileNBC News ProfileParentSchool FairSD Consortium of Independent and Private SchoolsSummer Camp AdTABSTV NewsUnion Tribune SportsYahooYelpYouTubeDid you speak with a staff member before applying?*--Select--YesNoPlease provide the name of the staff member you spoke to about the camp.* Please provide a first or last name.Financial ResponsibilityPlease review our camp pricing options here before continuing.Responsible Party First Name* Responsible Party Last Name* Relationship to Camper*--Select--Parent - MotherParent - FatherLegal GuardianGrandparentOther RelativeOtherTuition 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.CAPTCHA