2025 Youth Wellness Summer Camp

Youth Wellness Summer Camp
Gentlemen's Quest will be hosting a 6 week summer camp. If you are interested in enrolling, please fill out the form below! 25 students will be selected. Once you are accepted, you will receive an email with details.

The Youth Wellness Summer Camp, partnered with House of Skinner Wellness, aims to address the pressing issues of physical health, nutrition, and overall well-being among youth ages 8-14 by offering a 6-week summer camp. The program details are as follows:

Start Date: June 2, 2025

End Date: July 10, 2025

Program Duration: 6 weeks

Weekly Schedule: 4 days per week

Daily Hours: 5.5 hours per day

Program Components:

Healthy Meals: Each participating student will receive a well-balanced, nutritious meal for lunch every day, addressing the issue of food insecurity and promoting better dietary habits.

Physical Activity: The program will include exercise sessions and outdoor activities designed to keep students active and promote a healthier lifestyle.

Nutrition Education: Cooking classes will be conducted to teach students about making healthier food choices and preparing nutritious meals.

Reading/Literacy Activities: Camp participants will engage in weekly activities designed to improve reading ability while fostering a love of reading.

Mentorship: Each student will be paired with a dedicated Success Coach to set personal goals and monitor their progress throughout the summer.
- Student Full Name*
  
  First NameLast Name
- Participant Type*
  
  AdultMinor ChildTeen ParentProfessional
- Gender*
  
  MaleFemaleRefused to AnswerNot Available
- Race*
  
  BlackWhiteAsianHispanicAmerican Indian or Alaska NativeNative Hawaiian or other Pacific IslanderTwo or more racesRefused to AnswerNot Available
- Ethnicity*
  
  Hispanic or LatinoNot Hispanic or LatinoRefused to AnswerNot Available
- Date of Birth*
  
  MonthDayYear
  Date
- Student School ID
- What grade will your student be in next school year?*
  
  3456789
- Student School
- Shirt Size*
  
  Youth SmallYouth MediumYouth LargeYouth XLAdult SmallAdult MediumAdult LargeAdult XL
- What session do you want to register for? Please note that if your student is accepted to attend this camp, they must be able to attend each camp session. Camp will be held on Monday through Thursday each week.*
  
  Option A: June 2 - July 10, 2025
- Will your student be able to attend all 23 camp days?*
  
  YesNo
- The Youth Wellness Camp will take place at Crossover Church, 1235 E Fowler Avenue, Tampa, FL 33612. Crossover Church will provide us with a classroom and gymnasium. Will your student have transportation to ensure that he arrives to the camp site on time each day?*
  
  YesNo
- What is your goal for your student this summer? (Select all that apply.)*
  
  To be active during the summerTo develop healthy eating habitsTo lose weightTo develop self-confidence and/or increase self-esteemTo become more athleticTo get help with team building and working with othersTo get a positive male role modelTo be around other young men headed in a positive directionTo get help with behavior/attitudeTo improve reading ability
- Does your student have access to their own personal laptop or desktop computer in your home?*
  
  YesNo
- Does your student have internet access in your home?*
  
  YesNo
- Head of Household:*
  
  Male (Single) Head of HouseholdFemale (Single) Head of HouseholdOther-Relative/Kinship Care (Single) Head of HouseholdDual 2-Parent HouseholdDual 2 Other-Relatives/Kinship CareOtherNot Available
- # of Adults Living in Your Home:*
- # of Children Living in Your Home:*
- Free or Reduced Lunch Status (for data purposes only)*
  
  YesNoDid Not ReplyNot Available
- Household Income:*
  
  Less than $20,000$20,000 to $34,999$35,000 to $49,999$50,000 to $74,999$75,000 to $99,999Over $100,000
- Highest Education Level in Household*
  
  Some or no high schoolHigh school graduateTechnical certificateSome collegeAssociates degreeBachelors DegreeAdvanced DegreeRefused to AnswerNot Available
- Student Email Address*
  example@example.com
- Student Phone Number*
  
  Area CodePhone Number
- Student Preferred Contact Method
  
  EmailPhone
- Student Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Parent Name*
  
  First NameLast Name
- Parent Email Address*
  example@example.com
- Parent Phone Number*
  
  Area CodePhone Number
- Parent Preferred Contact Method
  
  EmailPhone
- Emergency Contact Name*
- Emergency Contact Phone Number*
- Allergies, Medications, or Medical Concerns
- Waiver Form Instructions
  
  This is an electronic version of our parent waiver form and to be filled out by a parent/legal guardian only. Please initial below for each of the following items to indicate your permission and complete the electronic signature before submitting your Youth Wellness Camp registration.
- I give permission for my student to participate in the Youth Wellness Summer Camp sponsored by the Gentlemen's Quest of Tampa Inc. [initial below]*
- I give permission for my student to have contact with the personnel of the Gentlemen’s Quest of Tampa Inc. and their designee regarding activities, field trips, academics, and behavior. [initial below]*
- I give Gentlemen’s Quest permission to photograph my student and use his likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration. [initial below]*
- I give permission for my student to be transported by the Gentlemen’s Quest of Tampa Inc. and their designee to sponsored activities and field trips. [initial below]*
- I give my student permission to attend any field trip sponsored and/or facilitated by the Gentlemen’s Quest of Tampa Inc. I also understand that unanticipated situations and problems can arise in any trip and I agree to release and hold harmless the program, its agents, employees, and volunteers, from any and all liability, claims, suits, demands, judgements, costs, interest and expense, (including attorney’s fees and costs) arising from such activities, including any incident or injury to the student and the costs of medical services. [initial below]*
- I consent to and authorize the personnel of the Gentlemen’s Quest of Tampa Inc. and their designee to take whatever reasonable steps he/she deems necessary in order to provide emergency medical care for my child. I further agree to permit my child to be transported to a medical facility by ambulance or other commercial vehicle. [initial below]*
- I consent to and authorize Gentlemen’s Quest of Tampa Inc. to share program-related data (including but not limited to demographic, attendance, and performance data) with the following organizations for evaluation and reporting purposes: (1) Children's Board of Hillsborough County, (2) Corporation to Develop Communities of Tampa. [initial below]*
- I will ensure that my child attends the camp each day and arrives on time.*
- I understand that if my child does not complete the camp, the capstone project, or misses a day, he/she will forfeit any incentives.*
- By typing your full legal name below, you are signing this Parent Waiver Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.*
- Please verify that you are human*
- Should be Empty:

Youth Wellness Summer Camp

Waiver Form Instructions