2026 Green Grid Leadership Academy Registration

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* 1. First & Last Name

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* 2. Date of Birth

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* 3. Age (as of June 1st)

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* 4. School Name

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* 5. Last Grade Completed

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* 6. Home Zip Code

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* 7. Race/Ethnicity

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Other Pacific Islander

White

Other

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* 8. Gender

Male

Female

Non-binary

Prefer not to say

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* 9. T-Shirt Size

AXL

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* 10. Primary Contact Name

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* 11. Relationship to Camper

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* 12. Phone Number

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* 13. Email Address

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* 14. Home Address

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* 15. Zip Code

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* 16. Food Allergies/Dietary Restrictions

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* 17. Emergency Contact (Secondary)

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* 18. Emergency Phone

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* 19. Field Trip Fee Acknowledgment-$100

I understand this fee secures my child’s spot and covers transportation/entry fees for summer field trips.

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* 20. Attendance Policy Acknowledgment

I understand that consistent attendance is vital for my child to complete the solar-power and gardening projects.

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* 21. Photo Release Permission

I give permission for my child to be included in photos/videos for Legacies United Foundation and City of Columbus project reports.

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* 22. Capacity Notice Acknowledgment

I understand that registration is limited to 75 students. If the program is full, I will be added to the waiting list.

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* 23. Therapeutic Behavioral Health (Optional)
Our specialists offer integrated support for social-emotional learning and behavioral needs through 1-on-1 coaching, peer "Dialogue Sessions," and family advocacy. Would you like to learn more or have your child screened for eligibility for these supportive services?

YES, I am interested in individual/group behavioral health support for my child.

NO, I am not interested at this time.