Sophienburg Summer Camp Enrollment Form

Sophienburg Summer Camp Registration
Please select the session you wish to sign your camper up for:*

July 8 - 10, 2025 - 9:00 AM – 12:00 PM - 5th – 8th Grade for 2025-2026
CAMPER INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade for 2025-2026*
T-Shirt Size*
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*
Parent/Guardian E-mail*
example@example.com

Photo/Video Release
PERMISSION TO USE PHOTOGRAPHS AND VIDEOS

By selecting "Yes" below, I hereby grant to The Sophienburg Museum & Archives ("The Sophienburg") and its representatives the right to take photographs and/or videos of me and/or my child(ren) in connection with camp activities, and to use, publish, and copyright such images in print and/or electronic form.

I authorize The Sophienburg to use these images for purposes including, but not limited to:
- Publication on The Sophienburg website
- Social media accounts operated by The Sophienburg
- Promotional materials and publications
- Educational materials
- Archival purposes
I understand and agree that:
- No compensation will be provided for the use of these images.
- These images may be edited, altered, or modified at The Sophienburg's discretion.
- These images may be used with or without my name or my child(ren)'s names.
- The Sophienburg owns the copyright to all such images.
- This authorization remains effective until revoked by me in writing.
I hereby release and discharge The Sophienburg and its representatives from any and all claims and demands arising out of or in connection with the use of the photographs and/or videos, including without limitation any and all claims for libel or invasion of privacy.

By selecting "Yes," I confirm that:
- I am 18 years of age or older and competent to contract in my own name, OR
- I am the parent or legal guardian of the child(ren) being registered, and I am competent to sign this release on their behalf.
By completing the registration process, I acknowledge that I have read and understood this release.
Yes, I grant permission for The Sophienburg to use photographs/videos as described above.No, I do not grant permission for The Sophienburg to use photographs/videos.

MEDICAL INFORMATION
Does your child have any allergies?*

FoodMedicationEnvironmentalNoneOther
Please list and explain any allergies:
Physician Name*

First NameLast Name
Phone Number*
Medical Concerns

Emergency Contact

In the event of an emergency, we will first call 911, then immediately notify the camper's designated emergency contact.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Authorized Pickup Persons
Name*

First NameLast Name
Name

First NameLast Name
Name

First NameLast Name

Select and pay for the session you are signing you camper up for:

July 8 - 10, 2025 - 9:00 AM – 12:00 PM - 5th – 8th Grade for 2025-2026

$75.00

Total

$0.00

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

Should be Empty:

Sophienburg Summer Camp Registration

CAMPER INFORMATION:

PARENT/GUARDIAN INFORMATION:

Photo/Video Release

MEDICAL INFORMATION

Emergency Contact

Authorized Pickup Persons