Alex Foundation's Architecture + Design Summer Camp 2024 Registration

Alex Foundation’s Architecture + Design FREE Summer Camp 2025

Fill out the form carefully for registration.
Online Registration Form

Thank you for your interest in Alex Foundation's 2025 Architecture+ Design Summer Camp. Spaces will be filled on a first come, first serve basis and this form must be received by the Alex Foundation prior to the start of our summer camp in order for your child to be registered. There are spaces for 12 campers each week for rising 7th grade students; and you will be notified by phone, mail or email to confirm your child’s place. *This summer camp is for current 6th graders going to the 7th grade only.
Applications are OPEN and will CLOSE Monday, April 28, 2025 (deadline).

* Note that the form cannot be saved, so gather all necessary information and complete and submit the form in one session.

* Please use appropriate upper and lower case letters in the entries.

* Please print the form to keep for your own records before submitting.
STUDENT INFORMATION
Student Name*

First NameLast NamePreferred Name, ONLY list one
Current Grade Level (you must currently be in the 6th grade to apply )*
Birth Date

MonthDayYear
Student E-mail*
example@example.com
Student's Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*
Mobile Number*
Ethnicity (More than one may be checked)*

AsianBlack/Africian AmericanHispanic/LatinoNative American/Alaska NativeNative Hawaiian/Pacific IslanderWhite
School*
District*
County Where School is Located*
PARENT/GUARDIAN INFORMATION
Parent's Name (Primary Contact)

First NameLast Name
Parent's Email
example@example.com
Parent's Phone Number
Please enter a valid phone number.
Parent's Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.
Please list the names and phone numbers of all people authorized to pick up your child:
DESIGN SUMMER CAMP INFORMATION

Choose One
My child will attend July 14 - 18, 2025 Hours: 9:00AM - 4:00PM:

YesNo
My child will attend July 21 - 25, 2025 Hours: 9:00AM - 4:00PM:

YesNo
STUDENT TRANSPORTATION

Choose One
My child will need transportation to summer camp at 9:00AM:

YesNo
My child will need transportation home at 4:00PM:

YesNo
NOTE: (If you checked the boxes above, you will be contacted to confirm if transportation can be provided. Please only choose this option if you have no other transportation for your child.)
LIABILITY WAIVER (Health Information)
Do you have any allergies?

YesNoIf yes, please list all allergies _________________________________________________
Do you have any dietary restrictions?

YesNoIf yes, please list dietary restrictions_________________________________________________
Do you have any health concerns we should know about?

YesNoIf yes, please list health concerns_________________________________________________
Medications (including inhalers):

YesNoNote: If your child must take medication while at camp, please note here. All medications must be in their original containers and be appropriately labeled. Medications must be received and held by the office or with the program directors,
RELEASE, WAIVER and AGREEMENT
Please Read Carefully and Sign

Being a participant of the activities hosted by the Alex Foundation, I hereby freely and voluntarily, without duress, execute this Release and Waiver of Liability Form under the following terms:

Waiver and Release. I hereby release and forever discharge and hold harmless the ALEX FOUNDATION and its successors and assigns from any and all liability claims, demands, and causes of action, of whatever kind of nature, either in law or equity, which may hereafter arise from my being present at ALEX FOUNDATION and its property.

I understand and acknowledge that this Release discharges ALEX FOUNDATION from any liability or claim that I may have against ALEX FOUNDATION with respect to any bodily or other injury, illness, death or property damage that may result from my being present at ALEX FOUNDATION. I also understand that ALEX FOUNDATION does not assume any responsibility or obligation to provide financial assistance, including, but not limited to, medical, health, or disability insurance, in the event of injury, illness death, or property damage.

Insurance. I understand that except as otherwise agreed in writing, the ALEX FOUNDATION does not carry or maintain health, medical, disability, damage, liability, or other insurance coverage for the benefit of any person and expressly disclaims the responsibility or obligation to do so. I am expected and encouraged by ALEX FOUNDATION to maintain medical, health, and all other applicable insurance coverage for my own benefit.

Medical Treatment. I hereby release and forever discharge ALEX FOUNDATION from any and all claims, demands and causes of action whatsoever that may arise or may hereafter arise on account of any first aid or other medical treatment rendered on the premises of ALEX FOUNDATION. Relating to the child to be registered, I hereby give permission to the Alex Foundation Architecture + Design Summer Camp: To provide transportation to off-site program areas or for medical attention as deemed appropriate by the Camp Director and to designate a Camp Physician, in an emergency and I cannot be reached, who will secure proper treatment for, and/or order injections, hospitalization, anesthetics or surgery.

Assumption of Risk. I understand that my presence at ALEX FOUNDATION Architecture + Design Summer Camp for whatever purpose and/or any projects, activities or events sponsored, managed, arranged or promoted by, or otherwise affiliated or associated with ALEX FOUNDATION may include activities that may be hazardous to me. I further recognize and understand that such participation may involve certain inherently dangerous activities. I hereby expressly and specifically assume the risk of injury or harm in the activities and release ALEX FOUNDATION from all liability for injury, illness, death and/or property damage that may result.

Photographic Release. I do hereby grant and convey unto ALEX FOUNDATION. all rights, titles, and interest in and to any and all photographic images and video or audio recording made by or on behalf of ALEX FOUNDATION or made with its consent, during my participation with ALEX FOUNDATION and/or any projects, activities or events sponsored, managed, arranged, or promoted by, or otherwise affiliated or associated with ALEX FOUNDATION, including but not limited to, any royalties, proceeds, or other benefits derived from such photographs or recording.

Program Specific. Rules for participation in the program are uniform for everyone regardless of race, color, national origin, gender or disability. It may be understood that all participants will be treated equally as individuals and respect shown for normal differences in tastes, preferences, abilities and behavioral patterns. The Alex Foundation Architecture + Design Summer Camp reserves the right to make the determination when or if it may be necessary to have a child withdrawn from the program and to withhold all fees should withdrawal be for purposes of maintaining the welfare or safety of the child or other program participants. Drugs, alcohol and weapons are prohibited and possession of such items will result in immediate withdrawal from the program. Punctuality is important: Program activities will start promptly at 9 am and end at 4pm each day. Please only register your child if you can commit to this.
Guardian Signature

Clear
Date

MonthDayYear
Date
COVID-19 WAIVER

Even with precautions and safety measures, there is still a possibility of contracting COVID-19. By attending Alex Foundation Summer Design Camp and signing this release, waiver and agreement, participants acknowledge they will do their best to help prevent the spread of COVID-19 and know that there is always a risk even with training and enhanced safety measures. Therefore, we require that every participant read this document, agree to the terms, sign and date the form. By signing this form, you acknowledge Alex Foundations safety measures and will uphold the safety precautions required of you.

On behalf of myself and/or my child/ward (as the case may be) and as a condition of myself, and/or my child/ward attending this workshop, I hereby acknowledge and agree to assume ALL risks known and unknown, including COVID-19, associated with attending this workshop, including its staff and volunteers (hereinafter collectively “RELEASEES”) and I hereby agree to RELEASE, INDEMNIFY AND HOLD HARMLESS all RELEASEES from and against any and all such claims, actions, suits, damages, liabilities (and the like) arising out of or in connection with, directly or indirectly, COVID-19 and any other risk associated with this summer camp, including, but not limited to, costs, expenses and attorney fees.

I have read and agree to the liability waiver above (must be signed by a parent or guardian if attendee is under 18 years old):*

Covid Protocols

Participants should stay home if they:

·        Have tested positive for Covid-19

Participants should contact Alex Foundation staff before arriving if they:

·        Are awaiting COVID-19 test results

·        Have been exposed in the past 14 days: Exposure is defined as being with someone who has COVID-19 or is suspected of having COVID-19 while you were:

o   Within 6 feet for more than 15 minutes during a 24-hour period;

o   Masked or unmasked;

o   Indoors or outdoors;

o   Had direct physical contact with the individual;

o   Shared eating or drinking utensils;

o   Coughed or sneezed on

BY SIGNING BELOW, YOU ACKNOWLEDGE HAVING READ AND UNDERSTOOD ALL OF THE ABOVE-TERMS AND CONDITIONS. (Must be signed by a parent or guardian if attendee is under 18 years old):*
Parent Signature (for youth under 18)

Clear
Date

MonthDayYear
Date
Please contact Alex Foundation at info@alex-foundation.org or call (870) 538-4853 for any questions or for more information.
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Alex Foundation’s Architecture + Design FREE Summer Camp 2025

Online Registration Form

STUDENT INFORMATION

PARENT/GUARDIAN INFORMATION

DESIGN SUMMER CAMP INFORMATION

STUDENT TRANSPORTATION

LIABILITY WAIVER (Health Information)

RELEASE, WAIVER and AGREEMENT

Please Read Carefully and Sign

COVID-19 WAIVER

Please contact Alex Foundation at info@alex-foundation.org or call (870) 538-4853 for any questions or for more information.