2025 MH101 Camp Limited Registration

Primary Parent Name*

First NameLast Name

Relationship*

Phone Number*

Please enter a valid phone number.

Primary Parent Email *

example@example.com

Secondary Contact Name*

First NameLast Name

Secondary Phone*

Relationship*

Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Camper Name*

First NameLast Name

Date of Birth (month/day/year)*

Grade for 2024-25 School Year*

School attended in 2024-25*

Shirt Size (only select one)*

Are there any health concerns including physical, psychiatric, or behavioral problems of which we need to be aware*

YesNo

If "Yes" Please describe -

Are there any medications, dietary restrictions, or allergies that we need to be aware of to ensure that your child's camp experience is positive*

YesNo

If "Yes" Please describe medications, dietary, or allergies

Action Required: Sport Selection for 2025 Camp

This year's camp will feature a variety of sporting events, clinics, and instructional sessions. Spots are limited to 20 campers per sport and will be allocated on a first-come, first-served basis

Please take action by selecting your child's preference of sport from 1 (first choice) to 4 (last choice

If no selections are made or the form is incomplete, we may assign your child to a sport with available slots or reject their application. This is an active camp, and all youth are required to participate in the scheduled events.

First Choice for preference of sport

Second Choice for preference of sport

Third Choice for preference of sport

Fourth Choice for preference of sport

I acknowledge that my child*

Does have permission to swimDoes not have permission to swim

Please describe your child's water skills. Do they have swimming experience? Do they require flotation devices?

Does the camper have any immunization exemptions because of parental or guardian objection or medical contradictions?*

YesNo

Youth Camper's code of conduct:

Respect: Treat fellow campers, staff, and the environment with respect. Listen to others and value their opinions.
Safety: Follow all safety guidelines and instructions from camp staff. Always stay within designated areas and use equipment responsibly.
Behavior: Maintain a positive attitude and avoid disruptive behavior. Bullying, harassment, and any form of violence are strictly prohibited.
Participation: Engage actively in all camp activities and be open to trying new things. Support and encourage your peers.
Responsibility: Take care of your belongings and camp property. Clean up after yourself and help keep the campgrounds tidy.
Honesty: Be truthful in your interactions and actions. Report any issues or concerns to camp staff immediately.
Inclusivity: Embrace diversity and be inclusive of all campers, regardless of their background or abilities.
Health: Maintain personal hygiene and follow health guidelines. Inform camp staff of any medical needs or concerns.
Curfew: Adhere to camp curfews and schedules. Ensure you are in your designated sleeping area at the appropriate times.
Fun: Enjoy the camp experience, make new friends, and create lasting memories!
Feel free to customize this code of conduct to better fit the specific needs and values of your camp. Is there anything else you'd like to add or modify?

By typing my name, I am stating that I am authorized to complete this form on behalf of the participant and the participant will adhere to the Youth Camper's code of conduct *

I hereby consent to have my child, named above, attend and participate in the 2025 District 9 and Manhood 101 Mentoring & STEM Camp. I understand that participation in camp activities involves inherent risks and potential for injury. By providing my consent, I acknowledge these risks and agree to release and hold harmless Omega Gold Development Group, Sydney Harrison, Prince George’s County Public Schools, Prince George's County Government, and any of their staff, subsidiaries, affiliates, or successors from any damages, injuries, or legal liability that may arise from my child's participation in the camp of whatever kind related to me or my child’s attendance and participation. I further acknowledge and understand that participation is voluntary and that I am knowingly waiving my and my child’s right to seek any damages against any of the aforementioned organizations as a result of their participation in this event.

By typing my name, I am stating that I am authorized to complete this form on behalf of the participant *

Omega Gold Development Group, Inc (OGDG) and their affiliates periodically uses photographs, videos, profiles and stories for programs that are promotional, advertising, commercial, educational, research and/or archival in nature. As such, OGDG and their affiliates collect on an ongoing basis individual and group photos and testimonials relating to our volunteers, supporters and activities.

We ask for permission to use your (child’s) photo, videos, profile and/or story in promotional material to promote and benefit our projects and programs.

I hereby grant OGDG and their affiliates the irrevocable right and unrestricted permission to use and publish photographs or video images of me (my child), or in which I may be included, for any purpose authorized by OGDG, including but not limited to: website use, editorial publications, catalog and advertising use. This includes the right to modify and retouch the images in the discretion of OGDG. I understand that the circulation of such materials could be worldwide and that there will be no compensation to me for this use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products or the advertising copy or the printed matter that may be used in connection therewith. In granting this permission to OGDG and their affiliates, I am fully and without limitation releasing it from any liability that may arise from the use of the images.

By typing my name, I am stating that I am authorized to complete this form on behalf of the named camper *

By signing my name, I am stating that I am authorized to complete this entire form on behalf of the named camper *

Date Signed*

Date

Refund Policy

We understand that plans can change, and we strive to accommodate our campers as best as possible. Our refund policy is as follows:

Refund: If cancellation is made more than 3 days after application is submitted, minus 3% processing fee

No Refund: If cancellation is made less than 3 days before after application is submitted.

Cancellation Due to Medical Reasons:

Refund: If a camper is unable to attend due to medical reasons, a refund, minus 3% processing fee, will be issued upon submission of a valid medical certificate.

Camp Cancellation:

Full Refund: If the camp is cancelled by the organizers for any reason, a full refund will be issued to all registered campers.

Processing Time:

Refunds will be processed within 14 days of receiving the cancellation request.
Please note that all refund requests must be submitted in writing to MH101@OGDGINC.COM . We appreciate your understanding and cooperation.

My Products*

Application FeeApplication and Payment Policy To ensure a smooth and organized registration process, we require each camper to submit a completed application along with the necessary payment. Please note that: 1. Applications will not be reviewed without payment. 2. All payments are final. 3.Refunds will be issued only under specific circumstances as outlined in our refund policy.

$50.00 Quantity

Total

$0.00

Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info

2025 District 9 and Manhood 101 Application

Camper's Information

Acknowledgment

Release of Liability

Photo Waiver