Super Kids Creativity Camp Registration Form

Registration
Child's Information
Child's Name*

First NameLast Name
Birth Date

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number
Does your child have any allergies, chronic illness, or medical conditions? If yes, please describe.*

Super Kids Creativity Camp*

7-8 Year Old RegistrationJune 17-21 from 10:00 am - 12:00 noon at the Ruby C. Fulbright Aquatic Center.120 Paul Franklin Rd, Clarkesville, GA 30523

$185.00 Quantity

9-10 Year Old RegistrationJune 17-21 from 1:00 pm - 3:00 pm at the Ruby C. Fulbright Aquatic Center.120 Paul Franklin Rd, Clarkesville, GA 30523

$185.00 Quantity

Total

$0.00

Credit Card

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ACH Bank Transfer

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Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Super Kids Creativity Camp during the selected camp. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Super Kids Creativity Camp, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participation in selected camp sessions.

In case of injury to said child, I hereby waive all claims against Super Kids Activity Camp, including all teachers and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
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.
Date*

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