All Fields must be completed in order to be considered for participation in Key Leader. If a field is not applicable please enter N/A
Your Email Address
Address (Street, City, State, Zip Code)
Date of Birth (yyyy-mm-dd)
Student Attendee ($50)Student Facilitator (No Charge)Chaperone (No Charge)
Additional Student Information (required for all Student Attendees)
Name of School
Year of Graduation
How did you hear about Key Leader?
Are you a member of?
Key ClubBuilders ClubNeither
Have you attended a Key Leader event before?
Do You have any special needs (dietary or physical, etc) that we need to let the camp know about?
Parent or Guardian Name and Phone (XXX-XXX-XXXX)
Are you interested in being a student facilitator? (students who are interested in facilitating small groups in discussions and activities. Student facilitators must be committed to leading a group of 8-10 peers throughout the weekend. Those that have previously attended Key Leader will be considered first.) If so, an additional questionnaire will be emailed to you after registration.
Sponsoring Kiwanis Club or Key Club (if applicable)
Sponsor Email address
Sponsor Phone Number
I would like to receive more information regarding Kiwanis Key Club membership
Submitting this form by clicking on the "Send Message" button below, does not constitute acceptance into Key Leader. Further, if selected for participation in Key Leader you will be required to pay a $50 fee as a student participant (not required for student facilitators) as well as submit the medical release and media release forms prior to Key Leader weekend.