Summer Camp Registration Form

Summer Camp Registration
Camper Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
Medical Information
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
Photo Release Acknowledgement

I hereby acknowledge and grant permission to Future Leaders of Tomorrow Academy to use photographs or videos of my child, taken during their time at the school.

I understand that these photographs or videos may be used for various school-related purposes, including but not limited to, school publications, promotional materials, social media, and the school's website.

I release Future Leaders of Tomorrow Academy from any liability or claims arising out of the use of the photographs or videos.

I understand that this permission is ongoing and will remain in effect.
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 EQUAL TO AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature
Should be Empty:

Summer Camp Registration

Camper Information