Summer Camp Registration Template

SICOM Summer Youth Jobskill Training Registration

For (ages 14-17) Orange Mound
Registration ends Friday May 23, 2025
Student Information
Student's Name*

First NameLast Name
Birth Date*

MonthDayYear
Please select your current grade level7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
Sibling's Name ATTENDING Camp (optional)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Name*

First NameLast Name
Cell Number*

Area CodePhone Number
E-mail*
Confirm E-mail*
example@example.com
STATE & COUNTY does your child attend school in?*
Emergency Information Other than the name listed above
Emergency Contact's Name*

First NameLast Name
Relationship*
Emergency Contact Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
Did you "Refer a Friend"? Please tell us the registered camper you invited to attend the camp.
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by (Serving In Christ Outreach) during the selected camp. (Serving In Christ Outreach) does not take responsibility for transportation, but we will offer assistance if needed. Furthermore, we will assure that each student will receive training in conflict resolution, understanding consequences, customer service skills, active listening, and how to fill out an application within 6 weeks.
AgreeI do not agree
Media Disclosure (Serving In Christ Outreach) may periodically photograph students participating and working during camp. These photographs may be used in a variety of ways; Public relations and marketing purposes: images printed on brochures, posters, and newsletters, or on (Serving In Christ Outreach) Website, Facebook Page, and/or other art, education, or news related publications. Please indicate whether you will allow publication of photographs taken of your child/children and their literacy work during classes. Names will not be included in photographs or posted on social media. We appreciate your support and would love the chance to share pictures of all of the fun being had at our Youth Summer JobSkill Training. You can also follow us on Facebook to capture all of the pictures yourself!
AgreeI do not agree
Registration Fee $40 Covers T-Shirt and supplies
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.
Signature
Should be Empty:

SICOM Summer Youth Jobskill Training Registration