City Sculpting Summer Registration Form 2025

City Sculpting Registration Form
Child's Information
Child's Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Gender*

MaleFemaleNon-binary
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*
E-mail*
example@example.com
Name of Parent/Guardian #2 (if applicable)

First NameLast Name
Cell Number
Email
Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Does the child have any allergies, chronic illness, medical, or behavioral conditions? If yes, please describe and give any necessary instruction*
Medical Insurance Information*

Name of Insurance ProviderPolicy Number
Informed Consent and Acknowledgement

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

In case of injury to said child, I hereby waive all claims against City Sculpting. including all staff, all participants, and owners and lessors of premises used to conduct the event.
Medical Release and Authorization

In Case of Medical Emergency, if I cannot be contacted, I hereby give permission to a City Sculpting staff member and the physician he/she selects to secure proper treatment, including: hospitalization, ordering injections, giving anesthesia, x-rays, routine tests, treatment, transporting of child, or performing operations as may be urgently necessary for this child and to release reports necessary for insurance purposes for my son/daughter noted above. This form may be copied for emergency purposes. I understand that every effort will be made to contact the camper's responsible parent or guardian. I further understand that if I do not have medical insurance that covers all costs, I will be responsible for such medical costs.
Publicity Release

I give City Sculpting permission to audio, video, and photography of this registering camper for the purposes of City Sculpting sales and promotions without compensation or approval rights (i.e. highlight promotional videos and photos for our website and socail media).
Please check your answer

I AgreeI Disagree
Any other notes you would like to add:
Where did you hear about us?
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.
Electronic Signature*

First NameLast Name
Please check the weeks you are registering for below to check out

PLEASE READ: If paying via Zelle, do not check any boxes and just press submit form. If registering a sibling, please pay full price for the first sibling and use coupon code SIBLING below to get 10% off the sibling(s).

To pay with card, Select the week(s) you are registering for:

Week 1: July 14 - July 18

$600.00

Week 2: July 21 - July 25

$600.00

Week 3: July 28 - August 1

$600.00

Week 1 (HYBRID WORKSHOP 10+): July 14 - 18

$650.00 Quantity

Week 2 (HYBRID WORKSHOP 10+): July 21 - July 25, 2025

$650.00 Quantity

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

City Sculpting Registration Form

Please check the weeks you are registering for below to check out