Summer Registration Form

Summer Camp Registration Form
Student Information

**Please submit one registration form per child.
Student Full Name*

First NameLast Name
Grade Level for Fall of '24*
School Attending in the Fall*
Gender*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Please list all allergies and any treatments. If none, please type none.*
How is your child's reading proficiency?
Any academic diagnosis?
Please tell us a little bit about your child.
Feel free to share any concerns, motivators, specific interests, or other relevant information about your child.
Parent Information
Parent Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
Emergency Contact (other than parent listed above)*

First NameLast Name
Relationship to camper*
Phone Number*
Please enter a valid phone number.

PERMISSIONS
I, the undersigned parent or guardian, give permission for my child to participate in all camp activities. I authorize the camp organizers to seek emergency medical treatment if necessary.

AgreeDisagree
I, the undersigned parent or guardian, give permission to use photos and/or videos of my child, for promotional purposes such as social media and marketing. This permission is granted indefinitely unless revoked in writing.

AgreeDisagree
I, the undersigned parent or guardian, understand the cancellations policy Cancellations made 30 days or more before the camp start date will be eligible for a full refund. For cancellations after 30 days before the first day of the camp a partial refund of 50% will be considered. Unfortunately, no refunds will be issued for cancellations made less than 7 days before the camp begins. Registration transfers to another session may be requested, subject to availability. All cancellation requests must be submitted in writing to info@iheartlearningacademy.com, and refunds, when applicable, will be processed within 7 days. Exceptions to this policy may be considered in cases of medical emergencies or unforeseen circumstances, with documentation possibly required. By registering for our summer camp, you acknowledge and agree to comply with the terms outlined in this cancellation policy. Thank you for your understanding and cooperation.

Agree
Please be aware that each camp requires a minimum of 3 participants. Should the camp not reach this threshold, you will be notified two weeks prior with the option to reschedule or receive a full refund.

Agree

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Summer Camp Registration Form

PERMISSIONS

Payment Methods