Student Participant Registration Please select your payment type: You are sponsored or You need to make a payment. * Payment Type: -- choose -- Sponsored (paid for by a Kiwanis Club or other organization) Payment by Credit Card Payment by Check Registration allowed immediately without pre-payment or code. Paid by Kiwanis Club, parent, or other organization after registration is submitted. Checks can be made payable to:KYDS Club of San Diego Foundation645 Front Street, Unit 1103San Diego, CA 92101Please write "Key Leader" on the memo line and the names of any students sponsored. Funds pre-paid by Kiwanis Club, parent, or other organization. Unique code is created and required for online registration. * Sponsor Code: Sub Total: $250.00 Sponsored: $0.00All of this sponsor money has been used. Transaction Fee: $0.00 Grand Total: $250.00 Student Registration Information * First Name: * Last Name: * Preferred Name: * Address: Address 2: * City: * State: -- choose -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY * Zip: * Phone: Cell Phone: * Name of School: * Year in School: -- choose -- 8th 9th 10th 11th 12th * Date of Birth: mm 1 2 3 4 5 6 7 8 9 10 11 12 dd 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 yyyy 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 * Gender: -- choose -- Male Female Other * Preferred Pronoun: -- choose -- He/Him/His She/Her/Hers They/Them/Their * Email: * How did you hear about Key Leader? -- choose -- Key Club/Kiwanis Club Principal/Counselor/Teacher FFA National Student Council Convention Parent/Guardian KIWINS Other * Are you a member of: -- choose -- Key Club Builders Club Kiwanis Kiwin's Other Sponsor (if applicable-club/organization): * Sponsor Name: * Sponsor Email: * Sponsor Phone: Do you have any special needs (dietary or physical, etc) that we need to let the camp know about? * Emergency Contact Name: * Emergency Contact Phone: * Relationship to Emergency Contact: Billing Information Same As Above * First Name: * Last Name: * Address: Address 2: * City: * State: -- choose -- AK AL AR AS AZ CA CO CT DC DE FL FM GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MP MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY * Zip: Payment Information * Name on Card: * Card Type: Visa Mastercard American Express Discover * Card Number: * Card Expiration: mm 01 02 03 04 05 06 07 08 09 10 11 12 / yyyy 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 * Security Code: Payment Totals Sub Total: $250.00 Sponsored: $0.00 Registration Fee: $0.00 Transaction Fee: $0.00 Grand Total: $250.00 Cancellation Policy All CANCELLATIONS must be received in WRITING. You may email to keyleadercedarglen@gmail.com or mail to Kiwanis Key Leader (Camp Cedar Glen) Attn: Valerie Crawford and/or Geoff Tobias KYDS Club of San Diego 645 Front Street, Unit 1103 San Diego, CA 92101 Phone cancellations will not be accepted. $25 of all registrations are non-refundable. Balance may be refunded from written requests received by 5 pm on Tuesday, October 3, 2023. No refunds will be granted after October 3, 2023. I acknowledge the cancellation policy for this event. I acknowledge the Key Leader program has been designed as a complete educational experience from 4 pm on Friday afternoon through 11:30 am on Sunday morning. All participants are expected to attend the full experience and these values will be in effect during this whole time. I acknowledge the Registration needs to be paid in full by October 1, 2023. I acknowledge the following forms will be sent to me via email and they will be reviewed/completed by the start of registration at 4pm Friday. -CalPac Camps Welcome Waiver -Key Leader Medical Authorization -Key Leader Community Values I acknowledge I am responsible for arranging my own transportation to and from camp. I acknowledge a copy of my registration and/or invoice may be shared with the following: parent(s)/guardian(s), sponsor(s) and/or Kiwanis.