2025 - 2026 Kids Camp After School Registration Form
Student Information
Student Name
*
First Name
Last Name
Student's Date of Birth
*
/
Month
/
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2025 - 2026 Grade
*
School
*
Robert E Lee
East Lincoln
Bel-Aire
Jack T Farrar
Homeschool
Please select how which days your child will need after school care. Once you submit your registration, a member of our staff will reach out to you to confirm your enrollment and start date.
*
Monday
Tuesday
Wednesday
Thursday
Friday
When would you like to start?
*
-
Month
-
Day
Year
Date
Parent's Name
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Employer
*
Email
*
example@example.com
Parent's Name
First Name
Last Name
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Employer
Email
example@example.com
Emergency Contact Information
(other than parent/guardians listed during registration)
Emergency Contact #1
*
First Name
Last Name
Relationship to child
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Pick Up Authorization
Who may pick up your child besides parent/guardian listed above?
Please include emergency contacts if applicable. Note: Children will not be released other than to those on this list. Photo identification may be required from anyone other than a parent or guardian. You are able to add to this list in the future.
*
Health Record
List all allergies, any special precautions and treatment indicated for these allergies (ie: food, medication or environmental allergies).
Please be sure to include ALL food allergies, medications, or modified diets currently being administered to your child. List all chronic illnesses, history of hospitalizations or anything else the staff would need to know to properly care for your child.You may type "N/A" if this question is not applicable.
*
List all medications or modified diets currently being administered to your child.
*
You may type "N/A" if this question is not applicable.
List all chronic illnesses, history of hospitalizations or anything else the staff would need to know to properly care for your child.
*
You may type "N/A" if this question is not applicable.
Health Statement: please select which option describes your child:
*
My child is in good health, is able to participate in group care, has no special health or medical requirements.
My child is able to participate in group care but has special health or medical requirements as listed above.
Policy Agreement
I give permission for my child to participate in Kids Camp activities such as group led enrichment, movies, outdoor play, etc. at TGC. I give permission for my child to be included in pictures or other publicity connected with the camp, including Instagram, Facebook and other social media platforms. I understand that accounts must be paid in full for my child to participate. If my child is not picked up by the designated time, a $35 fee will apply for each occurrence.
*
I HAVE READ AND UNDERSTAND ALL POLICIES.
Credit/Debit Card Agreement
TGC policy requires that all clients have a credit or debit card on file for payment purposes. Your Credit/Debit Card information will be secure and can only be charged under the terms you specify below. By providing us with your Credit/Debit Card Information, you authorize TGC to automatically charge your card on a monthly basis if another payment is not secured, unless full payment is provided. Cards will be run each Thursday for the following week. Parents will be immediately notified if the card on file cannot adequately charge fees. If the Credit/Debit Card information on file changes for any reason, you must notify TGC as soon as possible. We will maintain a clear record of all payments and charges. An email receipt will be sent to you as soon as the payment goes through.
*
I HAVE READ AND UNDERSTAND THE CREDIT/DEBIT CARD ON FILE AGREEMENT AND AUTHORIZE TGC TO CHARGE MY CREDIT/DEBIT CARD THE AGREED-UPON FEES.
Cardholder Name
*
First Name
Last Name
Number
*
Exp MM/YYYY
*
I am aware of the nature of this activity and I hereby assume responsibility for the participant listed above to participate. I acknowledge that, while not common, any activity that involves height and motion (such as bounce houses, tumbling, and stunting) involves risk of injury ranging from minor (bruises and sprains) to more serious an catastrophic injuries. I will not hold Tullahoma Gymnastics and Cheer (TGC) or its employees responsible in the case of accident or injury as a result of this participation. I understand that this completed form must be in the possession of TGC prior to participation in any program. If, at any point, I have question or a concern regarding the safety of my child or the intent of the program, I will contact the owner or manager immediately. I will also allow the participant listed to be photographed and videotaped for publicity and advertising purposes only.
*
I HAVE READ AND AGREE TO THE PARTICIPATION WAIVER.
Waiver of Liability
Transportation Waiver
Students will be transported on the TGC Bus from their respective school. In the event that bus transportation fails, students will be transported via Kids Camp staff personal vehicles. Students are required to wear seatbelts and follow bus/transportation rules at all times. Students who do not follow the bus rules will receive a warning followed by a parent notification.
*
I HAVE READ AND AGREE TO THE TRANSPORTATION WAIVER.
Parent/Guardian Signature
*
My Products
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Kids Camp After School Care Registration Fee
$
20.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Submit
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