Wufoo

American Delegation Application - Part One

Click here if you wish to preview Parts Two and Three of this application.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Home Phone *
Mobile Phone
Date of Birth / MM / DD YYYY
Social Security Number

This information will be used for the application process only.
Name of School Attending
Grade in School
Eighth Grade Ninth Grade Tenth Grade Eleventh Grade Twelth Grade
Father's Name First Last
Father's Email
Is your father's address the same as yours?
Yes No
Mother's Name First Last
Mother's Email
Is your mother's address the same as yours?
Yes No
Session you prefer to attend *
Session One Preferred Session One Only Sesion Two Preferred Session Two Only
Camp Information

Please list your prior camp experiences below.
Camp Name / Location / Position
Camp Name / Location / Position
If you attended overnight camp, did you encounter any problems being away from home?
Yes No
Volunteer / Community Service

Please list volunteer or community service organizations you have been involved in.
Organization / Position / Date(s)
Organization / Position / Date(s)
Reference

Please list a reference who we can contact to discuss your application if needed. It is NOT necessary to send letters along with your application.
Reference Name *

Please list reference who we can contact to discuss your application if needed.
Reference Phone # - (###) - ### ####
Reference Email
Relationship to Reference
Additional Information
Languages Spoken
Condition of your health
Allergies
Restrictions on food or activities
Interests / Hobbies / Skills

Please check any of the below activities that you enjoy or have experience in.
Baseball Street Hockey Tennis Soccer Volleyball Ropes Course Swimming Sailing Canoeing Water Skiing Drama Music Crafts Conflict-resolution Peer Leadership Mediation / Negotiation
After you click the Submit button, you will be directed to Parts Two and Three of this application.

Click here if you wish to preview Parts Two and Three of this application.
Do Not Fill This Out

Wufoo

American Delegation Application - Part One

Camp Information

Volunteer / Community Service

Reference

Additional Information

Interests / Hobbies / Skills