Student Facilitator Registration

Please select your payment type: You are sponsored or You need to make a payment.

* Are you a member of:

* Payment Type:

Sub Total:

$100.00

Discount Total:

$0.00

Transaction Fee:

$3.00

Grand Total:

$103.00

Student Facilitator Registration Information

* First Name:

* Last Name:

* Address:

Address 2:

* City:

* State:

* Zip:

* Phone:

Cell Phone:

* Name of School:

* Year in School:

* Date of Birth:

* Gender:

* Email:

* How did you hear about Key Leader?

Do you have any special needs (dietary or physical, etc) that we need to let the camp know about?

* Emergency Contact Name:

* Emergency Contact Phone:

* Relationship to Emergency Contact:

* How will you get to camp?:

Billing Information Same As Above

* First Name:
* Last Name:
* Address:
Address 2:
* City:
* State:
* Zip:

Payment Information

* Name on Card:

* Card Type:

* Card Number:

* Card Expiration:

* Security Code:

Payment Totals

Sub Total:	$100.00
Discount Total:	$0.00
Registration Fee:	$0.00
Transaction Fee:	$3.00
Grand Total:	$103.00

Cancellation Policy

All CANCELLATIONS must be received in WRITING. You may email to carolinaskeyleader@gmail.com. Phone cancellations will not be accepted.

$25 of all registrations are non-refundable. Balance may be refunded from written requests received by 5 pm on Friday, October 14, 2022. No Refunds will be granted after October 14, 2022.

I acknowledge the cancellation policy for this event.

I acknowledge the Key Leader program has been designed as a complete educational experience from 4 pm on Friday afternoon through 11:30 am on Sunday morning. All participants are expected to attend the full experience and these values will be in effect during this whole time.

I acknowledge the Registration needs to be paid in full by October 21, 2022.

I acknowledge the following forms will be sent to me via email and they will be reviewed/completed by the start of registration at 4pm Friday.
-Medical Release Form/Rope Course Waiver
-Community Values
-YMCA Release and Waiver of Liability (Form A)

I acknowledge I am responsible for arranging my own transportation to and from camp.

I acknowledge I will be at camp by 2pm for the Student Facilitator Meeting with the Lead Facilitator.