MLTR Adult registration

Adult Registration Form - MLTR 2026
Contact information
Name

First NameLast Name
Preferred First Name (for name tag)
Session you are attending
Have you attended this specific program before?
What school are you representing at this session?
School not listed?
Email Address
example@example.com
Your Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Dorm Preference?
Pronouns

Other
Race/Ethnicity (Optional)
Mobile Phone
Please enter a valid phone numberFormat: (000) 000-0000.
Home Phone
Please enter a valid phone numberFormat: (000) 000-0000.
Home Address
City State Zip code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What county do you live in?
Medical Information
Medical Insurance Company
Policy Number
Primary Care Provider
Date of Last Tetanus Shot
Any current medications to be taken at this session?
Medications information (name/dose/time of day)
Can a health care professional provide over the counter medications?
Any notes on over the counter medications?
Are you restricted from any type of activity?
Please describe limited type of activity
Do you have a peanut allergy?
Is your peanut allergy airborne or ingested?
Do you have a life threatening allergy?
Please provide details and will you be bringing an epi-pen?
Dietary requirements (As we serve family style, we are only able to accommodate the diets below)
Other dietary, health concerns or allergies:
Do you have any support needs or disability accommodations that you would like the directors to know about?
Details to share with directors related to my needs while at camp...you may also attach a document at the end of this registration form.
Emergency Contact
Emergency Contact

First NameLast Name
Emergency Contact 1 Preferred Phone
Please enter a valid phone numberFormat: (000) 000-0000.
Relationship with emergency contact
Alternate Emergency Contact

First NameLast Name
Alternate Emergency Contact Preferred Phone
Please enter a valid phone numberFormat: (000) 000-0000.
Relationship with alternate emergency contact
Document upload: If you have any medical form/instructions to share, please upload below
As a participant, I agree to abide by all regulations established by the officials of the Association of Washington Student Leaders and site specific regulations (Cispus/Pinelow) and will strive to represent my school/district by contributing my best efforts toward the success of the camp. I have read and understand the cancellation policy and I understand that student drivers are not allowed.
Document upload

Cancelof
Should be Empty:

Adult Registration Form - MLTR 2026

Contact information

Medical Information

Emergency Contact

Document upload: If you have any medical form/instructions to share, please upload below