LEAP Summer Camp Registration Form 2026

Student Information

Student's Name

First NameLast Name

Birth Date

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Grade

Gender

Has the student applicant or sibling participated in LEAP Summer Camp before?

Yes or no

T-Shirt Size

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Additional Parent/ Guardian Name

First NameLast Name

Additional Parent/ Guardian Phone

Area CodePhone Number

Phone Number

Area CodePhone Number

Phone Number

Area CodePhone Number

How did you find out about the LEAP Summer Camp?

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the student have any dietary restrictions, allergies, chronic illness, or medical conditions? If yes, please describe.

Daily pickup time is 3:30 PM. Will you be able to pick up your child at this time?

Required Video Submission

As part of the LEAP Camp application, please submit a short video (1 minute or less) of your child answering TWO of the questions below:

Why do you want to join LEAP Camp?
What kind of story would you like to write?
Why would you be a great LEAP Camp Author?

Upload Video

Video file only. Please keep the clip between 30 seconds and 1 minute.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Storytime Village during the LEAP Summer Camp. In exchange for the acceptance of said child’s candidacy by Storytime Village, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Storytime Village and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Storytime Village including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.

Medical Release and Authorization

As Parent and/or Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is also granted to Storytime Village and its affiliates including staff, and camp directors to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the camp.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Policies

Lost or Stolen Items
Campers are asked to leave any valuables and electronics at home. Storytime Village and its employees are not responsible for lost or stolen items.

Photographs
I give my permission for my child’s photograph or video to be taken for use by the Storytime Village in program brochures, website, social media sites and other promotional materials and for release to local newspapers.

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.