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Registration Form: 2022 Empowering Youth Leadership Institute

Empowering Youth Leadership Institute will begin on Monday, July 25th at 3:00pm and end Wednesday, July 27th at 12:00pm. 

Please fill out this permission form and we will send you a welcome registration packet at the beginning of July. With questions, please contact EmpowerMT at info@empowermt.org

 

Contact Information
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First Name
Last Name
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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
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(if not applicable write none.)
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(if not applicable write none.)
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Please arrive at Camp Paxson at 3:00pm on Monday, July 25th.
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Parent Guardian info:
For participants 18 and under
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First Name
Last Name


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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
Emergency contact info:
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First Name
Last Name
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Waiver & Release:
By checking the boxes below, I apply my legal initials indicating I have carefully read, clearly understand, and voluntarily sign this waiver and release agreement.
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For participants 18 and under
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