Effective Leadership Academy Program Registration

Program Selection
Welcome! Please choose which Camp LEAD Online program your student will attend.
Month*
Please select which month you want your child to attend Camp LEAD Online.
- June
JUNE Camp LEAD Online Session*
All Camp LEAD Online sessions run Monday through Friday.

June 7 – 11, 9am – 10:30AM
Student Information
Please complete this section with the student's information.
Add up to 3 students
New Participant or Alumni?*
If the participant is new to ELA programming, select NEW. If the participant has gone through ELA programming before, select ALUMNI.
- NEW
- ALUMNI
Student Information*
Student First Name Student Last Name
Student Grade*
Student Email (If none, enter Guardian Email)*
Student Mobile Phone*
Student's Current School*
Student Mailing Address*
Student Street Address 1 Student Street Address 2 Student City Student State Student Zip Code
Gender*
We collect this information for our grant-making purposes.
- Male
- Female
- Non-Binary
Ethnicity (optional)
We collect this information for our grant-making purposes.
- African American
- Asian/Pacific Islander
- Caucasian (White)
- Hispanic (Non-white)
- Multi-racial
Add a 2nd Student?
Add another student for this Camp LEAD Online session?
Click yes if you would like to input information for another student who will attend the Camp LEAD Online session at the same date and time chosen for the first student.
- Yes
- No
2nd Student: New Participant or Alumni?*
If the participant is new to ELA programming, select NEW. If the participant has gone through ELA programming before, select ALUMNI.
- NEW
- ALUMNI
2nd Student Information*
Student First Name Student Last Name
2nd Student Grade*
2nd Student Email (If none, enter Guardian Email)*
2nd Student Mobile Phone*
2nd Student's Current School*
2nd Student Mailing Address*
Same Student Mailing Address

Student Street Address 1 Student Street Address 2 Student City Student State Student Zip Code
2nd Student Gender*
We collect this information for our grant-making purposes.
- Male
- Female
- Non-Binary
2nd Student Ethnicity (optional)
We collect this information for our grant-making purposes.
- African American
- Asian/Pacific Islander
- Caucasian (White)
- Hispanic (Non-white)
- Multi-racial
Add a 3rd Student?
Add another student for this Camp LEAD Online session?
Click yes if you would like to input information for another student who will attend the Camp LEAD Online session at the same date and time chosen for the first student.
- Yes
- No
3rd Student: New Participant or Alumni?*
If the participant is new to ELA programming, select NEW. If the participant has gone through ELA programming before, select ALUMNI.
- NEW
- ALUMNI
3rd Student Information*
Student First Name Student Last Name
3rd Student Grade*
3rd Student Email (If none, enter Guardian Email)*
3rd Student Mobile Phone*
3rd Student's Current School*
3rd Student Mailing Address*
Same Student Mailing Address

Student Street Address 1 Student Street Address 2 Student City Student State Student Zip Code
3rd Student Gender*
We collect this information for our grant-making purposes.
- Male
- Female
- Non-Binary
3rd Student Ethnicity (optional)
We collect this information for our grant-making purposes.
- African American
- Asian/Pacific Islander
- Caucasian (White)
- Hispanic (Non-white)
- Multi-racial
Guardian Information
Please complete this section with your information.
Guardian Information*
Guardian First Name Guardian Last Name
Guardian Email*
Guardian Phone*
Preferred contact number.
Mailing Address*
Same as Student Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Liability & Releases
Video & Audio Conferencing Release*
I hereby grant my permission to ELA to take my child’s photo/video while participating in ELA Online activities to use for future publicity.
- Agree
- Do Not Agree
Payment Information
2021 Camp LEAD Online
Tuition - 1 Student
$99/student
Refund Policy
A full refund will be issued if the selected Camp LEAD Online session is canceled by ELA for any reason, and your student is unable to transfer to a different Camp LEAD Online session.

In any other situation, the registration price includes a nonrefundable $25 fee. The remaining balance of the registration cost is refundable up to five (5) days prior to the start of the program. All cancellations after this time will result in a loss of the entire amount paid.
Price:
2021 Camp LEAD Online
Tuition - 2 Students
$99/student
Refund Policy
A full refund will be issued if the selected Camp LEAD Online session is canceled by ELA for any reason, and your student is unable to transfer to a different Camp LEAD Online session.

In any other situation, the registration price includes a nonrefundable $25 fee. The remaining balance of the registration cost is refundable up to five (5) days prior to the start of the program. All cancellations after this time will result in a loss of the entire amount paid.
Price:
2021 Camp LEAD Online
Tuition - 3 Students
$99/student
Refund Policy
A full refund will be issued if the selected Camp LEAD Online session is canceled by ELA for any reason, and your student is unable to transfer to a different Camp LEAD Online session.

In any other situation, the registration price includes a nonrefundable $25 fee. The remaining balance of the registration cost is refundable up to five (5) days prior to the start of the program. All cancellations after this time will result in a loss of the entire amount paid.
Price:
Total
$0.00
Credit Card/PayPal Payment Only*
When paying with a credit card, after hitting submit, you will be taken to PayPal to complete your payment. You do not need a PayPal account to complete payment.
- I Understand the Credit Card/PayPal Payment Process
Feedback
How did you hear about ELA?*
Take a moment to let us know how you found out about ELA!

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Add referral name here.
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Registration Form - 2021 Camp LEAD Online

Program Selection

Student Information

Add a 2nd Student?

Add a 3rd Student?

Guardian Information

Liability & Releases

Payment Information

Feedback

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