Climb for Leaders

If you are having trouble completing this form, please contact aliya@climbforleaders.com.

Participant (Student) Information

Select Season *

First Name *

Last Name *

Date of Birth (dd/mm/yyyy) *

Gender *

School *

Grade *

Address *

City *

Province/State *

Postal/Zip Code *

Daytime Phone *

Evening Phone *

Mobile Phone

Email Address *

Parent/Guardian 1 information

First Name *

Last Name *

Day Phone *

Evening Phone *

Mobile Phone

Email Address *

Parent/Guardian 2 information

First Name

Last Name

Day Phone

Evening Phone

Mobile Phone

Email Address

Agreement

I understand and agree to meet the following requirements:

Please mail a cheque for a non-refundable fee of US$400 in order to complete this application to Avidium Inc.(mailing information will be provided after you hit the SUBMIT button below)
Submit an essay entitled “What are the top three development challenges in the area I will be visiting, and how would I solve them?”

If selected, I agree to:

implement a training program with the Athletics Director or designate at my school
participate in learning sessions on development issues before the climb, and share my climb and travel experiences with the school after the climb
meet the minimum fund-raising requirement of $4,000
pay for all costs by the deadlines outlined
complete, sign and mail in the waiver and consent forms - you will be provided a link

Yes, I wish to apply to participate in the Climb for Leaders.