Middle School Camp Registration

Please take a moment to fill out this application and then click the submit button. If you would like a hard copy of the application, please contact our office and we will send you one.

Campers Information:

Name (First, Middle, Last)
Date of Birth (mm/dd/yyyy)
E-mail address
Parents Names

Mailing Address
City, ST, Zip

Home Phone Number
Sex:
Male Female
School Attending
Grade entering (as of August 2009)
Special Needs or Requests
Hometown Newspaper
Roommate Request (optional)
T-shirt Size:
Small Medium Large X-Large
XX-Large XXX-Large
Emergency Contact, Should Parents not be Available:
Name (First, Middle, Last)
Mailing Address
City, ST, Zip
Phone Number

 

How did you hear about KYLA?

 

Registration Fees:

$150 for early bird discount (due by May 21)

$170 for late registration (final deadline date May 28)
 

Payment Options: Please select your method of payment from the list below.


Check: Make checks payable to Kansas Youth Leadership Academy
........Please mail check to: KYLA, 600 Park St. Hays, KS 67601

Credit Card: (Please contact us by phone if paying with a credit card.)


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POLICIES AND PROCEDURES

CONFIRMATION
After registering you will receive a confirmation packet within 10 days of submitting your application.

CANCELLATIONS
All cancellations must be received in writing no later than the deadline date for the seminar or camp that you and/or your students are attending. Cancellations will not be accepted after that date and NO refund will be given.

PAYMENTS
All payments for camp are due on or before the deadline date of the camp that you are attending. A service charge of 1.5% per month will be applied to all past due accounts. Each camp offers an early bird discount. To receive this amount, the application and form of payment must be postmarked no later than the early bird discount for the camp you are attending.

ROOMMATE REQUEST
There are many factors that go into roommate placement and every effort will be made to honor your request. Placement requests are not guaranteed, and are taken in the order they are received. Early enrollment is advised to insure rooming with a friend. NO roommate changes will be made on the first day of camp.

WAIVERS
All campers that participate will be required to sign and complete two waivers for camp, one for the Academy and one for the ropes course that they will be participating in. This waiver will be available in a packet of information that will be sent to each camper upon registering. The wavier will be due back into the office ONE WEEK prior to the camp that they are participating in. This waiver must be in the possession of the Academy before any camper will be allowed to participant in ANY camp activities.

HOMESICKNESS
Every summer there are a few campers who are homesick. We try to make your child’s experience at camp satisfying prior to calling you. If they insist on calling you and if their homesickness results in the camper having to leave early, NO refund will be given for the remainder of camp missed.


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For any questions concerning this form or KYLA please contact:
KYLA
600 Park Street
Hays, KS 67601
(785) 628 5399
KYLA@fhsu.edu

Thanks for Registering!

 

  
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"Fortunately for the world, young people are not
easily discouraged."
-Dwight D. Eisenhower

 
Kansas Youth Leadership Academy, Center for Civic Leadership, 600 Park Street, Hays, KS 67601 • Tel 785-628-5399 • Fax 785-628-4051• Email kyla@fhsu.edu
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