Summer Camp Detailed Registration Form

Summer Camp Registration
Student Information
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Age*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name*

First NameLast Name
Home Number*
Cell Number*
E-mail*
example@example.com
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Alt. Phone Number*
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared and supervised by Rainbow Arc Academy during the summer camp sessions. I understand that my child may participate in a variety of activities including, but not limited to: outdoor play, water-based activities, field trips, creative arts, and group games.

In exchange for my child’s acceptance into the camp, I assume all risks related to normal physical activity and travel to and from scheduled sessions. I release and hold harmless Rainbow Arc Academy, its staff, volunteers, affiliates, and any partnering organizations from any liability arising from minor injuries or incidents that may occur during participation.
Medical Release and Authorization

In the event of a medical situation, I authorize Rainbow Arc Academy staff to seek appropriate first aid or emergency care for my child. I understand that efforts will be made to contact me immediately, and I take full responsibility for any medical expenses incurred as a result.
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.
Date

MonthDayYear
Date
Signature

Clear
Should be Empty:

Summer Camp Registration

Student Information