Youth LEAD Program Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Thank you for filling out our Youth LEAD application. 
We are excited for you to join us for an adventure this summer! 

Please fill out each field completely.

If you have any questions or would prefer to speak with an ETC Staff member, please contact Amy Yoger, the Youth LEAD Program Manager, at 415.474.7662 ext. 16 or ylp@etctrips.org.

APPLICANT





PARTICIPANT INFORMATION









DATE OF BIRTH 










PARENT/GUARDIAN INFORMATION





EMERGENCY CONTACT INFORMATION




SHORT ESSAY QUESTIONS



Personal References:
List two personal references with current contact information. 
No Relatives Please.










PARTICIPANT HEALTH QUESTIONNAIRE 
On each Youth LEAD course, participants from different backgrounds and experiences come together to develop as leaders, environmental stewards, and team members. For over two decades we have served individuals of all abilities, however, not every participant can be accommodated on their course of choice. Our courses also fill up during the spring enrollment period. We will do our best to accommodate your preferred course, but submitting an application does not guarantee you a spot on that course. 
Please submit early before courses fill up! 

Please take a moment to respond to the following questions related to the participant's health history. This questionnaire is required to finalize your registration 
and your responses will be kept confidential.

If you have any questions, or would prefer to speak with an ETC Staff member, please contact Amy Yoger, the Youth LEAD Program Manager, at 415.474.7662 ext. 16 or ylp@etctrips.org.