Summer Camp Activity Waiver Form

Youth Festival Activity Waiver Form

Presented by Jeremiah’s Sports Foundation
This year we have designed a Youth Festival where children can learn and become educated on the effects of gun violence in our communities from mentors, counselors, law enforcement, and coaches while also having fun!

Children will be split into 3 different age groups ranging from 6-9, 10-12, 13-16.
Name of the Child*

First NameLast Name
Name of the Parent/Guardian*

First NameLast Name
Parent/Guardian's Phone Number
Parent/Guardian's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Statement of Consent & Waiver

I hereby agree and declare that I am the legal parentguardian of the above-named child and hereby consent to the child's participation in the activities that are described to me in registration process. I understand that activities of the kind described may result in physical injury to my child but nonetheless specifically request that he or she be allowed to participate in those activities.

If the above-named child requires any emergency medical treatment or procedures during the activities, I hereby consent to activity supervisor(s) to make any decision and take any action to arrange for such procedures or treatments in the discretion of the activity supervisor(s).

I, the parent/guardian, hereby agree and declare that I have carefully read and understand the scope of the summer camp activities and I consent to the participation of the above-named child to these activities.

Jeremiah's Sports Foundation cannot be held responsible for any injury that may occur to the child without the fault of Jeremiah's Sports Foundation and activity supervisors.
Parent/Guardian Signature

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Youth Festival Activity Waiver Form