Virtual Young Teen Asthma & Wellness Camps (VYTAWC) Leader-in-Training (LIT, ages 15-19) Interest Form

Parent/Camper Information

Question Title

1. Please enter Name of Leader-in-Training (LIT) and his/her/their contact information (Please use separate surveys for multiple LITs).

LIT Name

LIT

Home (Mailing) Address

City/Town/State/Zip code

Parent/Guardian Name(s)

Parent/Guardian Email Address

Parent/Guardian Phone Number

LIT Email Address (Personal or School)

Alternate Email:

Alternate Phone:

Question Title

2. What school does your LIT attend & what is current grade?

Virtual Young Teen Asthma & Wellness Camp (ages 11-15, 1-week, is held in June or July ALL VIRTUAL).
LIT (ages 15-19) Trainings usually include a Monday in June (Virtual) then LIT may serve as a Group Leader During Camp.

Orientation sessions (Virtual) will be available for LITs/Parents/Guardians who indicate an interest.

For More Information or to discuss, contact Ellen Buckner, ebbuckner@gmail.com (205) 910-9877.

Virtual Young Teen Asthma & Wellness Camps (VYTAWC) Leader-in-Training (LIT, ages 15-19) Interest Form

Parent/Camper Information

Question Title

* 1. Please enter Name of Leader-in-Training (LIT) and his/her/their contact information (Please use separate surveys for multiple LITs).

Question Title

* 2. What school does your LIT attend & what is current grade?

1. Please enter Name of Leader-in-Training (LIT) and his/her/their contact information (Please use separate surveys for multiple LITs).

2. What school does your LIT attend & what is current grade?