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Participant Information Form.

We’re excited to embark on this journey with you! Before we get started, take a few minutes to tell us about yourself—this helps us get to know you and ensure you have the best experience possible.

Your Name*
First Last
Preferred Name
First Last
Preferred Email*

This is the email we will use for all Leadership Lancaster correspondence.
Cell Phone Number*
What is your unisex t-shirt size?*
Please share: One fun fact about you that most people don't know about AND an activity that brings you joy.*
Please submit a headshot for the directory.*
Accepted file types: png, jpg, Max. file size: 128 MB.
Do you have any food allergies or dietary restrictions?*
- Yes
- No
We will do our best to provide food options for everyone.
Please list them below
Do you have any medical and/or physical limitations that the team should know about?*
Please share any medical conditions, mobility needs, accessibility needs, or other health-related considerations that may help us better support you during the program (e.g., migraines, hearing loss, POTS, heart conditions, asthma, etc.). This information will be kept confidential and only shared with staff as needed.
- Yes
- No
Please list them below
Emergency Contact #1 Name
This person will be contacted first in the event of an emergency.
Emergency Contact #1 Relationship to You*
Emergency Contact #1 Phone*
Emergency Contact #2 Name
Emergency Contact #2 Relationship to You*
Emergency Contact #2 Phone*
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