ALP Application

Thank you for your interest in the Adirondack Leadership Program. Please fill out the application below to apply for the program. La Vida will contact you after we have received and reviewed your application. A $100 deposit is due after participants have been accepted into the program. Please make checks payable to "Gordon College" (we can no longer accept checks made out to "La Vida"—they will be returned). This form will timeout and erase answers after 30 minutes.

Adirondack Leadership Program Application

1. Name (last, first, middle initial)

2. Parent/Guardian Name

3. Street Address

4. City

5. State

6. Zip Code

7. Home Phone

8. Applicant's Cell Phone

9. Parent's Phone

10. Applicant's Email Address

11. Parent's Email Address

12. Please select the following:

Male
Female

13. Date of Birth

14. Age (at the time of ALP)

15. Current Year in School

16. T-shirt size

17. Height

18. ALP has a backpacking and a canoeing option. La Vida cannot guarantee, but will do its best to place participants in their trip of choice. Please indicate which trip you prefer.

Backpacking
Canoeing
I am flexible, either backpacking or canoeing.

19. Preferred Trip Dates:

Session 1: June 25-July 4
Session 2: July 9-July 18
Session 3: July 23-August 1

20. Why are you interested in the Adirondack Leadership Program?

21. Write a paragraph or more about a leader you want to be like and why.

22. What are two leadership qualities you hope to develop more during the ALP?

23. How did you hear about the Adirondack Leadership Program?

Mailing
Poster
Camp Fair
Attended camp before
Friend or family
Ad
Web
Mass Camps Website
Other

24. Referred By (please list the person who told you about ALP):

25. Please list two people that we may contact as references to your leadership potential and character. Include their NAME, PHONE NUMBER and EMAIL address.

26. Due to the strenuous nature of the activities and remote environment, are there any physical, emotional or mental health concerns we need to be aware of?

27. Are you taking any prescribed medications?

28. Are you allergic to bee stings? (Yes/No/Severity)

29. If yes, do you carry an EpiPen for your bee allergy? (If yes, please note you must bring your own EpiPen in addition to the ones we carry in the first-aid kit.)

Yes
No

30. Do you have any other allergies, especially foods? What foods and how severe?

31. Do you have any special dietary needs? Please check all that apply. (We cannot accommodate food preferences, but we will work with you regarding medical dietary needs. Please contact lavida@gordon.edu)

Vegetarian
Vegan
Lactose Intolerant
Gluten-Free
Celiac

32. The above information is true and written by the applicant for the ALP.

Yes
No

33. As a program of Gordon College, we may send you information regarding the school. If you wish to not receive these mailings, please indicate that below.

Yes, please send me information regarding Gordon College.
No thanks, I would prefer to NOT receive information regarding Gordon College