ALP Application

Thank you for your interest in the Adirondack Leadership Program. To apply, please fill out the application below. 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).

Please note that this form will time out and erase answers after 30 minutes.

Adirondack Leadership Program Application

We request that the students, not parents, fill out the application. GRADUATED REFUND SCHEDULE $100 registration deposit is nonrefundable. Cancellations before April 1: $650 refunded. Cancellations between April 1 and May 14: $375 refunded. Cancellations after May 15: NO refunds made

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 Cell 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)

	14
	15
	16
	17
	18

15. Current School You Attend and Year in School

16. 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.

17. Preferred Trip Dates:

	Session 1: June 28-July 7
	Session 2: July 12-July 21
	Session 3: July 26-August 4
	Session 4: August 14-August 23

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

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

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

21. ALP includes a faith component that will involve time spent in conversation specifically focusing on your own spiritual and faith development. Tell us a little bit about your desire for your own personal faith development on this trip.

22. 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

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

24. 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?

25. Are you taking any prescribed medications?

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

27. 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

28. Do you have any other allergies?

29. Do you have any food allergies or 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
	Nut Allergy

30. I have read and agree to the ALP cancellation policy and graduated fee refund schedule. Please see above for details on the cancellation policy and graduated fee schedule.

	Yes
	No

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

	Yes
	No

32. 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

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Gordon College, 255 Grapevine Road, Wenham, MA 01984
978.927.2300 | admissions@gordon.edu | info@gordon.edu

Gordon College is one of the nation's premier Christian colleges and located just north of Boston. We offer students extraordinary access to leading-edge opportunities for intellectual, professional, and leadership development to address the increasingly complex challenges of a global society. Gordon stands apart from other outstanding institutions in New England by combining an exceptional education with an informed Christian faith.