2026 Summer Camp Registration

Program Date and Hours:

May 26th - July 31

Early Drop-Off/Late Pickup Available: 7:30am-9:00am/Pick-Up 4:30-5:00pm at no extra charge.

Enrollment: - $180/week snd $100 one-time registration fee

Lunch Options: Children may bring their own lunch. A catered lunch will be provided some days. Some lunch prices and options vary each day depending on excursions planned.

All enrolled students will need to sign a Parent notarized affidavit and waiver. Element Adventures is license exempt facility per Alabama DHR guidelines/standards. All registrations are received and reviewed on a first come, first serve basis. Upon filling all open spots, all additional submissions will be added to our waiting list.

You will received an email with our itinerary for the week the Sunday before camp begins.

***$100 registration fee and Week 1 of camp due at time of registration to enroll for Summer Camp.***

**SIBLING DISCOUNT AVAILABLE**

No refunds, credits, or transfers. No weeks are prorated.

Additional information regarding attendance weeks, important things to know, and itinerary will be emailed after submission and approval.

First Name*

Last Name*

Birth Date*

MonthDayYear

Gender*

FemaleMale

Home Phone*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

School Attending*

Entering Grade for Current School Year*

Does Your Student Require a Child Safety Seat?*

Is this Student Returning or New to Element Adventures After School Care?*

Doctors Name*

First NameLast Name

Doctors Phone Number*

Expected Start Date*

Date

Full Name*

First NameLast Name

Relationship to Child*

E-mail*

example@example.com

Home Phone*

Cell Phone

Parent's Work Place

Work Phone

Where would you like to be reached while your child is at Element Adventures?*

Address - Same As Child*

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Parent/Guardian 1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name

First NameLast Name

Relationship to Child*

Home Phone*

E-mail

example@example.com

Cell Phone

Parent's Work Place

Where would you like to be reached while your child is at Element Adventures?*

Work Phone

Address - Same As Childs*

YesNo

If your address is different than the childs please fill out the info below. Otherwise move onto the next section.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Full Name*

First NameLast Name

Relationship to Child*

Home Phone*

Cell Phone

Work Phone

Does your child have any food, medication or environmental allergies?*

YesNo

If yes, please list any food, medication or environmental allergies

Does your child’s allergy/allergies require child care staff to monitor child for symptoms, take action if a reaction occurs, or give emergency medication to your child?*

YesNo

If yes please list.

Does your child have any medical conditions?*

Does your child require any medication? If yes, please list these medications.*

Do you authorize us to administer the medications listed above?*

YesNo

Please list the people authorized to pick up your child.*

I give my permission for Element Adventures to pick up my child from school and transport them to the Element Adventures facility.*

Agree

I understand that the Element Adventures After School Care Program is an active program with physically challenging activities available for student participation.*

Agree

I understand that climbing walls, indoor and outdoor play equipment, inflatable obstacles, slides, and basketball play entail certain risks. Those risks can include increased heart rate, blood pressure, strained or sprained muscles, fractured bones, partial or complete paralysis, heart attacks, psychological injury, death, or any possibility of other serious injuries. I elect to allow my child to participate in spite of these risks.*

Agree

I give permission for my child to be transported by Element Adventures staff to and from Element Adventures facility for field trips.*

Agree

I understand my child will be asked to sit quietly for a short period of time each afternoon to complete homework and/or reading. (Allowable personal electronic and/or gaming time is after homework time.)*

Agree

I understand my child may be photographed and photos may be used in media publications that would represent Element Adventures and its program in a positive manner.*

Agree

I knowingly and voluntarily assume all risks involved in my child's participation, and do hereby release Element Adventures, and its members, trustees, officers, employees, independent contractors and agents from any and all liability, damages, costs, and expenses arising out of or relating to bodily or psychological injury, loss of life or personal property that may occur as a result of participating in this program, regardless of the cause.*

Agree

I agree to give a two week written notice if I would like to withdraw my child from the program. The remaining balance must be paid in full at the time of notice.*

Agree

I understand that each week of care must be pre-paid two weeks in advance and weekly payments are due each Friday thereafter. There is a $15 late fee for accounts that fall past due.*

Agree

I understand that bad language and behavior that is disruptive, disrespectful, and/or aggressive will not be tolerated and further agree that dismissal of the student is at the discretion of the Program Director.*

Agree

Element Adventures has permission to secure emergency transportation for my child in the event of an illness or injury which requires emergency treatment. The emergency transportation service will determine the facility to which my child will be transported.*

Agree

My child and/or I have read, understand and accept the terms and conditions stated herein and acknowledge that this agreement shall be effective and binding upon the parties during the entire period of participation in the said program.*

Agree

Signature*

2026 Summer Camp

Student Information

Parent/Guardian Information 1

Parent/Guardian Information 2

Emergency Contact - Other than Parent/Guardian

Other Infomation

Credit Card