*Mobile users: Please type in birthdate (mm/dd/yyyy) if dropdown calendar does not save selection.

We collect this information for our grant-making purposes.

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In the event I cannot be reached in an emergency, I hereby give permission to the ELA Camp Director to order treatment and necessary transportation for my child to medical facilities. I give my permission to the physician/dentist to secure and administer treatment for my child named above.

I do hereby release ELA; its officers, employees, teachers, and coaches from all liability for any accident or injury that might be sustained through participation in this program.

I understand that ELA is not responsible for money, personal items, etc. lost during the program and I will discourage my child from bringing such items.

I hereby grant my permission to ELA to take my child’s photo/video while participating in the camp activities to use for future publicity or video programs.

Choose to pay with a credit card or by check. If paying with a credit card, after hitting submit, you will be taken to PayPal to complete your payment. Select this option if applying for scholarship assistance. If you'd prefer to pay for tuition by check, please make checks payable to Effective Leadership Academy and mail to 4480 Richmond Rd, Warrensville Heights, Ohio 44128.

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