WALKER ACADEMY CAREER INSTITUTE & YOUTH MINISTRY APPLICATION

WALKER ACADEMY CAREER INSTITUTE & YOUTH MINISTRY APPLICATION

Building Faith. Developing Leaders. Empowering Youth. Walker Academy Youth Ministry provides a safe, structured, and faith-based environment where youth are supported academically, spiritually, and personally. Through mentorship, education, and community engagement, we help young people discover their purpose and grow into confident leaders. There is an academy tuition fee associated with membership. A $100.00 registration fee is required, along with either $50.00 per week in tuition or $10.00 per day payment option.
Participant Full Legal Name

First NameLast Name
Participant Date of Birth

MonthDayYear
Date
Gender

Other
Student ID Number
Mailing/Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Guardian Email Address
example@example.com
Are you a U.S. citizen?
Do you have a high school diploma or GED?

Other
School Name
Graduation Year
Grade Level
Emergency Information

Please provide emergency contact details.
First Emergency Contact Name

First NameLast Name
Relationship to Applicant (Contact 1)
Emergency Contact Phone (Contact 1)
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone (Contact 1)
Please enter a valid phone number.Format: (000) 000-0000.
Second Emergency Contact Name

First NameLast Name
Relationship to Applicant (Contact 2)
Emergency Contact Phone (Contact 2)
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone (Contact 2)
Please enter a valid phone number.Format: (000) 000-0000.
Do you the participant have any medical conditions or allergies we should be aware of?
If yes, please explain your medical conditions or allergies.
Enrollment Agreement

Please read and sign below to acknowledge agreement.
I, agree to abide by all rules, policies, and procedures set forth by Walker Academy. I understand the nature of the program my child is enrolling in and am committed to fulfilling all attendance, participation, and payment obligations.
Signature
Date of Signature

MonthDayYear
Date
Transportation Waiver

Please read and sign below to acknowledge agreement.
I, authorize and give permission to Walker Academy Career Institute & Youth Ministry, its staff, volunteers, and representatives to transport, supervise, and allow my child to participate in all summer camp activities, educational trips, recreational events, ministry programs, and related activities during the Summer Camp 2026 program.
Signature
Date (Parent Signature)

MonthDayYear
Date
Photo & Media Release Form
Media Release Permission

YES – I give permission for Walker Academy, its staff, representatives, and affiliates to photograph, videotape, and/or record my image, likeness, voice, or work product. I authorize the use of these materials for any lawful purpose, including marketing, advertising, educational content, and promotional materials. I understand that these materials may be used in print or online, and I waive any rights to compensation or approval of the final products.
I understand that: • My name may be used in association with photos or media unless I request otherwise in writing. • These materials will become the property of Walker Academy. • I may revoke this consent at any time in writing by contacting Walker Academy’s administration.
Signature (Media Release)
Enrollment Fees

Please review the enrollment fee details below.
Registration Payment Option (check one)
Weekly Tuition Payment Option (check one)
Payment

Please use the link below to complete your payment.
Pay here
Date (Media Release)

MonthDayYear
Date
Should be Empty:

WALKER ACADEMY CAREER INSTITUTE & YOUTH MINISTRY APPLICATION

Emergency Information

Enrollment Agreement

Transportation Waiver

Photo & Media Release Form

Enrollment Fees

Payment