2025 Wave Scholarship Form

The Wave Program
Scholarship Form

July 7-17, 2025

The WAVE Program (TWP) Scholarship Form are for those families who are
experiencing financial burden in sending their kids TWP summer camp but unable to meet the registration donation of $125

TWP has been depended upon endowments, grants and fundraising to fund every
child’s participation in the program.

Nevertheless, TWP of Pacific Grove stands by our commitment to provide an
opportunity for all PG kids to participate, regardless of ability to pay.

Our scholarship request form is designed to be nonintrusive, requiring no additional documentation, but enables us to keep records to continue TWP.

Concerning TWP Request Scholarship

Yes, I would like to apply for and receive a Scholarship to the 2025 WAVE summer program.

Camper's Name*

First NameMiddle NameLast Name

Birth Date*

MonthDayYear

Gender

MaleFemale

What grade will the camper be going into at the beginning of the school year in August, 2025?

4th Grade6th Grade5th Grade7th Grade

What School Does Your Child Attend?*

Forest Grove Elementary SchoolRobert Down Elementary SchoolPacific Grove Middle School

T-Shirt Size (Check ONE size ONLY)

Parent/Guardian Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Work Phone*

Area CodePhone Number

Cell Phone*

Area CodePhone Number

E-mail*

Confirmation Email

I will attend the Parent Orientation meeting on Friday, june 27, 2025 at 6:30 p.m. in the PGHS Gymnasium*

YesNo

Photo Waiver

I grant to The Wave Program of Pacific Grove, its representatives and employees the right to take photographs of my child in connection with the above-identified subject. I authorize The Wave Program of Pacific Grove, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that The Wave Program of Pacific Grove may use such photographs of my child with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, web content and social media.

Please check*

Yes, I give permissionNo, I do not give permission

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship

Phone Number*

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Is your child attending have special needs?

YesNo

If your child attending camp is special needs, will he/she require an aide?

YesNo

Does the camper have any special needs, allergies, chronic illness, or medical conditions..etc, that we should be made aware of. Please explain.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by The Wave Program of Pacific Grove during the selected camp. In exchange for the acceptance of said child’s candidacy by The Wave Program of Pacific Grove. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless The Wave Program of Pacific Grove and Pacific Grove Unified School District and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against The Wave Program of Pacific Grove and Pacific Grove Unified School District including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible.

Permission is also granted to the The Wave Program of Pacific Grove. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Terms of This Agreement*

I have read and agree to the terms of this agreement for the Wave Program

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Attention Parents:

When you register your child up for a Wave Scholarship for thewaveprogram Summer Camp in 2024, and you do NOT receive a copy of the registration form you filled out in your email after hitting the SUBMIT button, please contact the registration coordinator, John Barker, Jr., at the email below and he will send you a copy in a pdf format.

jbarkerjr64@gmail.com

Camper Information