Leadership Camp Registration

Volunteer Name *

First Name

Last Name

Phone *

(###)

###

####

Can we text this number

Yes

No

Do you consent to your email/phone number being shared with the other Camp volunteers for planning purposes? *

Yes

No

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Female

Male

Non-Binary

Transgender

Prefer not to say

Date of Birth *

MM

DD

YYYY

Parent or Guardian Name *

First Name

Last Name

Emergency Contact Name *

First Name

Last Name

Phone *

(###)

###

####

Personal Reference Name *

First Name

Last Name

Phone *

(###)

###

####

By checking the box below, you are aware that the personal information shared in this form will only be used for the purpose of program registration and you agree to the disclosure of these details to Rebound's staff. *

I agree