Summer Day Camp Registration

1
Camper's Full Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.Students must turn 10 years old on or before July 16 (last day of camp) to participate in camp. Students eligible would have a birthdate on or before July 16, 2016.
Date
Month
Day
Year
3
Student Phone Number (Optional)
Please enter a valid phone number.
4
Grade (as of Fall 2026)* This field is required.
Please Select
Please Select
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other
5
Name of School that Camper will enter in Fall 2026 or indicate "homeschool".* This field is required.
6
Camp Selection* This field is required.Selecting the third option below means that your camper will complete the AI + Health + HUMANOID ROBOT Camp THEN join the second week of the ITY Summer Camp.
Camp 1: AI + Health + HUMANOID ROBOT Camp: July 6-9, 2026 (Middle School ONLY )
Camp 2: July 6-16, 2026 (Middle and High School)
Camp 1 + Join Camp 2 (Second Week Only)
7
T-Shirt Size* This field is required.
Please Select
Please Select
Youth XS
Youth S
Youth M
Youth L
Youth XL
Youth XXL
XS
S
M
L
XL
XXL
Other
8
How did you hear about the camp?* This field is required.
Please Select
Please Select
My camper previously attended ITY Summer Camp
Newspaper
Google or internet search
Social media or website
From a church
From a friend
Don't know / can't remember
Other
9
You selected "Other" as your response to "How did you hear about the camp?" Please provide additional details.
Huge
Large
Normal
Small
Ok
Ok
10
You selected "Church" as your response to "How did you hear about the camp?" Please provide the name of the church.
11
Has your camper participated in a previous Ignite Tech Youth's Summer Camp or Learn and Earn: Concession Stand Event?* This field is required.
Yes
No
12
Has your student been diagnosed (or not officially diagnosed) with any physical, emotional or educational learning needs that would require special accommodations at camp? If no, then type "NA". If yes, please explain.* This field is required.NOTE: This question is asked for resource planning purposes. This information does not, in any way, affect your application to ITY's Summer Camp. No student will be denied participation because of race, gender, religion, disability or national origin.
13
Special Dietary needs that have been Medically Diagnosed* This field is required.
None
Nut allergy
Gluten-free
Dairy-free
Vegetarian
Other
14
You selected "Other" for the Special Dietary Needs that have been Medically Diagnosed question. Please provide additional details:
15
Alternate Pickup: Persons Names, Relationship to Camper and Cell Numbers
Example: Person's Name , Relationship , Cell #
16
What is your race and/or ethnicity? Select all that apply.* This field is required.Demographic Information: The following information is requested so we may develop statistical reports for ITY and program supporters ONLY aggregate data will be shared. Summaries will not contain individual information. This information does not, in any way, affect your application to ITY's summer camp. No student will be denied participation because of race, gender, religion, disability or national origin.
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Other Race
Prefer not to answer
17
Parent/Guardian Full Name* This field is required.
First Name
Last Name
18
Parent/Guardian Email Address* This field is required.
example@example.com
19
Parent/Guardian Phone Number* This field is required.
Please enter a valid phone number.
20
Parent Orientation: Parent Orientation is tentatively scheduled for Thursday, June 25th. More details will be provided. You may participate in person or virtually (via Zoom). Would a parent or guardian be able to attend?* This field is required.
Yes
No
21
Company Where Parent/Guardian WorksWhy do we ask this question? We request this detail because some companies offer community support programs, grants, or volunteer resources for nonprofits connected to their employees. This information may help Ignite Tech Youth access additional resources that support student programs. This field is optional and will only be used for this purpose.
22
Emergency Contact Name* This field is required.
First Name
Last Name
23
Relationship to Camper* This field is required.
Please Select
Please Select
Mother
Father
Step Mom
Step Dad
Guardian
Aunt
Uncle
Family Friend
Other
24
Emergency Contact Cell Number* This field is required.
Please enter a valid phone number.
25
Media Release: By completing this following form, you as the parent/guardian is agreeing to the below statement on behalf of your student: I hereby grant permission to Ignite Tech Impact, Ignite Tech Youth and its affiliates (referred to as ITI) to use, including to display publicly or to perform, the minor’s image, likeness, or voice recording on the ITI website or in any other official ITI publications without further notice or compensation. I hereby consent that any such image, likeness, or voice contained in photographs and recordings are the property of ITI, which shall have the right to print, reprint, publish, copy, perform or represent publicly, or create derivative works based on and using the image, likeness, or voice depicted in such photograph, film, or sound recording as it may desire free and clear of any claim whatsoever on my part or the part of the above-named minor. I also understand that once the above-named minor’s image, likeness, or voice recording is published on a web site, it can be downloaded by any computer user. Personal information, such as a minor’s full name, parent/guardian’s full names, addresses and telephone number will never be published. Therefore, I agree to indemnify, defend and hold harmless ITI, its officers, employees, agents, successors and assignees (the “Indemnified Parties”) from and against any and all claims and liabilities resulting from this publishing.* This field is required.
I Agree
I Disagree
Should be Empty: