Session B of L.E.A.F! Academy JULY 20-24, 2026

L.E.A.F! Academy

Student Information
Thank you for registering for L.E.A.F! Academy (for students ages 13-15), where your child will experience leadership, exploration, and fun in Boone County's great outdoors. This program is the result of a partnership between the Boone County Conservation District (BCCDKY) and Boone County Parks Department. Our goals are to provide a safe, fun, and unique educational opportunity for your child.
Please fill out this form completely. Information in this form will be kept confidential and be used to keep your student safe during the program.
DATES: July 20,21, 22, 23 and 24, 2026

TIMES: 9am to 4pm each day

LOCATION: Varies each day. Please consult schedule (located at http://bccdky.org/l-e-a-f-academy/) for agenda.
To begin filling out the Student Information form, click next. Note that once you begin this form, you will not be able to save and come back to it later.

**IF YOU HAVE ADDITIONAL STUDENTS TO ADD, YOU WILL HAVE TO FILL THIS FORM OUT A SECOND TIME**

STUDENT INFORMATION
Student's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Current Grade
School Name
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Student's favorite outdoor activities:
Ex: hiking, soccer, fishing, etc.
T-Shirt Size
Student will attend camp on the following days (Please notify us of any changes prior to camp):

ADULTS AUTHORIZED TO PICK UP STUDENT

Pick up and drop off instructions will be given at a later date.
Adult 1:
Name

First NameLast Name
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Relationship to Student
Ex: Grandfather
Adult 2:
Name

First NameLast Name
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Relationship to Student
Ex: Family Friend

EMERGENCY CONTACT INFORMATION

Two emergency contacts other than the primary parent/guardian are required.
Parent/Guardian 1:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Relationship to Student
Ex: Aunt
Parent/Guardian 2:
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number

Area CodePhone Number
Cell Phone Number

Area CodePhone Number
Relationship to Student
Ex: Sister

HEALTH RECORD STATEMENT FOR STUDENT
PERMISSION TO TRANSPORT CHILD IN CASE OF EMERGENCY

Parents/Guardians will be contacted before transporting child to medical facility.

I give Boone County Conservation District / Boone County Parks staff and volunteers permission to transport my child to the specified below medical facility for emergency health care or to the nearest source of assistance.
Specified Medical Facility

Other
Child's Physician's Name:
Phone Number

Area CodePhone Number
Please sign to give permission (use cursor to sign):
Allergies
Ex: Peanuts, blueberries, and bee stings or N/A
Precautions
Ex: Do not ingest red drinks or N/A
Treatment
Ex: One 25mg Benadryl or N/A
Year of Last Tetanus Shot
If not sure, please type 0
Medications and/or Prescriptions currently administered to the camper:
Ex: 20mg Prozac or N/A
List any chronic physical problems and/or history of hospitalizations:
Ex: Scoliosis or N/A
List any other diseases, injuries, or behavioral issues which may affect the camper's ability to participate in activities such as hiking, snorkeling ,or fishing:
Ex: ADHD, OCD, broken arm or N/A

PARENT STATEMENT OF UNDERSTANDING
1. Parent or guardian listed on this application must sign their child (children) in and out of camp daily.
2. BCCDKY or Boone County Parks are not responsible for items that are lost or stolen.
3. There will be a $1.00 per minute late fee for any child left at camp after 4:30pm.
4. The parent or guardian is responsible for all guidelines as stated in the “Parent Handbook” (see below). Please read this document carefully.
I hereby give Boone County Conservation District, Boone County Parks and/or their partners permission to use my child’s image and likeness through photos and videos shared on websites, social media, and other print and electronic media.
I have read and understand the parent handbook and will not hold BCCDKY, Boone County Parks and/or their partners responsible for incidents outside the scope of safety policies and program guidelines
Student's Name

First NameLast Name
Parent's Name

First NameLast Name
Parent's Signature (use cursor to sign):

L.E.A.F! Academy Registration for ONE student$150.00

L.E.A.F! Academy Registration for TWO students$300.00

Subtotal Tax Total $0.00

L.E.A.F! Academy