2025 School Break Camp Enrollment Form
Located at 311 Aviation Rd Marietta, GA 30060
AfterPay available on this form
Camper's Information
Camper's Name
*
First Name
Last Name
Age
Gender
Please Select
Male
Female
Date of Birth
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
School Name
*
25-26 School/Grade Level
*
Camper's Photo
*
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Parent/Guardian Information
The parents/guardian listed below will be the authorized person to pick-up the child after the camp.
The parents/guardian listed below will also be the primary emergency contact person.
Parent 1 Name
First Name
Last Name
Relation
Phone Number
Parent 2 Name
First Name
Last Name
Relation
Phone Number
Medical Information
Does the child have any allergies? If yes, please list them below:
Does the child have any previous injuries? If yes, please explain them below:
Does the child have any current medical conditions? If yes, please list them below:
Does the child takes any medication? If yes, please list them below and explain its purpose:
How did you hear about us?
*
Previously Attended Camp or Class
Facebook
Instagram
Family/Friend
Street Sign or Billboard
Other
Payment Details
I, the parent/guardian of this camper gives authority to the staff of this camp to apply judgment in regards to medical assistance in the event of an accident, injury, or illness if the emergency contact person cannot be reached. I authorized first aid, medical/surgical diagnosis, and treatment which may deem necessary.
I released the organizers, coaches, staff, or managers of this camp for any responsibility in case of accident, illness, or injury during my child's enrollment.
I confirm that all information given in this form is true, complete, and accurate.
Parent/Guardian Signature
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Camper Registration Fee
One time fee per year, per camper. If paid during summer 2025, not required again.
$
30.00
Size
XS
S
M
L
XL
AS
AM
AL
Fall Break
September 22-25 (Monday-Thursday)
$
199.00
February Break
February 16-20
$
225.00
Payment Methods
Credit Card
Afterpay
After submitting the form, you will be redirected to Afterpay to complete the payment.
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