FP Leadership Program

FP Leadership Program Registration

The Adventure Continues!
CONTACT INFORMATION
Applicant Name

First NameLast Name
Applicant Email
Email
Applicant Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Zip Code
Age/Birthdate
Birthdate
Entering Grade/School
School
Which program(s) will you be attending?

FP Leadership Program: FP Extravaganza July 14-18WAITLIST: FP Leadership Program: FP Fusion July 21-25Staff Thank You Dinner (optional but fun!) July 25, 6-8pBokenka Japan Camp
T-shirt size

adult smalladult mediumadult largeadult XL

Program Fees (Junior Counselors are first 4 years of Leadership Program)

JC Fee: FP Extravaganza$625

WAITLIST: JC Fee: FP Fusion$975

Bokenka Japan Camp$2,000

Scholarship Donation$10

Thank you for keeping our doors open to all!

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Total $0.00

CONTACT INFORMATION (PRIMARY GUARDIAN)
Primary Guardian

First NameLast Name
E-mail
Primary Number

Area CodePhone Number
Authorization

Emergency ContactCan Pick-Up Applicant
Relationship to Applicant
CONTACT INFORMATION (OTHER ADULT)
Full Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Authorization

Emergency ContactCan Pick-Up Applicant
Relationship to Applicant

QUESTIONNAIRE for Applicants

There are no right or wrong answers to these questions. We are looking to get a sense of who you are in this moment, what you will bring to Feelosopher's Path, and what you hope to get out of the Leadership Program this year.
What are three words that describe you?
Why are you interested in the FP Leadership Program?
Tell us your adventure story:
What are you excited to share with our campers?
How will you share that awesomeness with campers?
What are your leadership strengths?
What leadership skills do you want to work on?

HEALTH INFORMATION by Parents

Your child's health and safety are important to us. Please be complete when filling out the following information, as it is our primary resource in case of emergency.
1. List any medical, physical, emotional, behavioral or social conditions that may affect your child's experience. Please also include any relevant medical treatment. If none, write 'none'.
Please provide any additional information or special tips to help us address these conditions at Feelosopher's Path.
2. List your child's allergies and dietary restrictions. If none, write 'none'.
Please describe the type and severity of reaction if your child is exposed to allergens as well as the requested course of action if an allergic reaction occurs:

WAIVER
Applicant's Name*
I, the undersigned parent/guardian of the above named student, do hereby consent to his/her participation in the Feelosopher's Path Program.*

I agree
I agree to follow Feelosopher's Path current COVID protocols and will notify them of any symptoms or exposures that occur.*

I agree
I acknowledge that participation in this program may expose the above named student to the possibility of injury. I grant Feelosopher's Path staff the authority to obtain emergency medical treatment as necessary to insure that the above named student is safe from further injury.*

I agree
I understand that while Feelosopher's Path staff strive to make the program as safe as reasonably possible, there exists always the possibility of injury or death due to the negligence of Feelosopher's Path staff before or after an injury occurs. Negligence means the failure to exercise the due care that a reasonable person would exercise under the circumstances. By signing below I hereby waive my right to pursue legal action based upon illness, injury, or death to my child.*

I agree
I hereby agree to indemnify and hold harmless Feelosopher's Path from any loss, liability, damage, or cost of any and all kind they may incur due to the participation of the above named student in the program and any activities incidental thereto, whether caused by the negligence of Feelosopher's Path or otherwise.*

I agree
I am aware that the above named student may appear in a photograph, or video, taken by staff or local media and that that photograph or video may appear in a variety of media sources on behalf of Feelosopher's Path. Feelosopher's Path will not divulge your child's name without written permission.*

I agree
I acknowledge that the above named student will be participating in activities, trips and events organized by Feelosopher's Path. I am aware that the participation of my student may be outside the scope of his/her daily routine. I give permission for my child to travel by foot, automobile, bus, or train to a desired location.*

I agree
Primary Guardian
Authorization Date

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Please verify that you are human*
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FP Leadership Program Registration