Student's Information

Legal Guardian's Information

Emergency Contact

Please provide two additional emergency contacts distinct from the individual mentioned above. Failure to do so will lead to an incomplete registration form.

To participate in the SWAG program, including transportation of the child listed above. The program is scheduled for Monday through Thursday each week and field trips. I give permission to the staff in SWAG program to contact, discuss or access my child's education, grades or records with teachers and administrators at the following school.

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Students With A Goal (SWAG) during the selected camp. In exchange for the acceptance of said child’s candidacy by SWAG ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless SWAG . 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 out-of-school sessions. In case of injury to said child, I hereby waive all claims against SWAG. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all activities, including physical education and recreation time. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the  SWAG. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Transportation Permission: I, the undersigned parent or legal guardian of the above-named student, hereby grant permission for my child to be transported by SWAG staff, volunteers, and collaborative partners for the 2024-25 school year (July 2024 - June 2025. This permission includes transportation to and from SWAG facilities, events, and home.

Drop-off Policy:

• Students will only be dropped off at the residential address listed on this application or the additional address provided below.
• If there is a need to change the drop-off addresses, please contact a member of the SWAG staff promptly.

By signing below, I acknowledge that I have read and understood the transportation policies and grant permission for my child to be transported by SWAG staff, volunteers, and collaborative partners as described above.

Confirmation By signing this agreement, I confirm that I have read, fully comprehend, and agree to abide by its terms.

By acknowledging and signing below, I am providing an electronic signature with the same legal effect as an original manual paper signature. The electronic signature will be equally binding as an original manual paper signature.