Summer Camp Detailed Registration Form

Summer Camp Registration
Campers Information
Campers Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Grade
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 the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by MDV KIDS during the selected camp. In exchange for the acceptance of said child’s candidacy by MDV KIDS ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless MDV KIDS . 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.

Registration assumes full participation for summer 2024. You may cancel enrollment by contacting MDV KIDS. Your first week payment is required at the time of sign up. There is a $10 late fee if tuition is not received by Monday Mornings of each week and a $25 fee for checks with insufficient funds - unless otherwise arranged. I hereby grant permission for my child to attend and participate in MDV KIDS program listed herein & agree to the Terms and Conditions set forth herein. Payment is still due on Monday even if child is absent to secure the students spot in the program. I am 18 years of age or older and the parent or legal guardian of the above-named child.
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

MonthDayYear
Date
Signature

Clear
Should be Empty:

Summer Camp Registration

Campers Information