Summer Camp Detailed Registration Form

July 5th - July 28th, 12:30 - 3:00pm

July 29th, Epic Adventure Day + Graduation Ceremony, 9:00 - 4:00pm

Child Information

If you need to register more than one child, please fill out a registration form for each child.

Child's Name

First Name Last Name

Birth Date

Month Day Year

Grade in Fall 2022

Gender

Male Female Other

What are FIVE of your child's AMAZING abilities?

What are TWO areas of growth that you'd like to see your child grow stronger?

What are THREE of your child's interests?

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Parent/Guardian Information

Name

First Name Last Name

Home Number

Cell Number

E-mail

example@example.com

There are several ways that family members can participate in the Summer Quest. Both the epic adventure day and graduation ceremony are memorable experiences for family members of all ages!

Yes, I'd like to learn more about ways to be involved I'd like to learn more about the graduation ceremony

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Alt. Phone Number

Does the child have any allergies, chronic illness, learning differences, or medical conditions? If yes, please describe. If needed, Superhero Training Academy will follow up with you.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by the Superhero Training Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by the Superhero Training Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Superhero Training Academy 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 Superhero Training Academy including all teaching artists and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Photo/Video Release I authorize the Superhero Training Academy to make picture and sound recordings, and use the same in any form for its purposes and consent that the photographs and videos may be copied, published, etc. for purposes of Superhero Training Academy promotion, information, etc., as needed, with the assurance that the participant's legal name will not be used with accompanying images or video.

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.

Signature for informed consent, acknowledgement, photo/video release

Clear

Summer Superhero Quest Registration