SMRCDC District 7 Summer Youth Parental Consent Form 2026
Complete this form to enroll your child in the District 7 Summer Camp Program. Please provide accurate information for student details, parent contacts, academic records, health issues, and emergency contacts.
Student Last Name
Student First Name
Student Middle Name
Address
Zip Code
Shelby County Commission District
Father Name
Mother’s Name
Father - Telephone (Work) Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mother - Telephone (Work) Number
Please enter a valid phone number.
Format: (000) 000-0000.
Father - Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Mother - Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Father - Email
example@example.com
Mother - Email
example@example.com
What grade will the participant be enrolling next year?
Participant’s Reading Scores from this year
Participant’s Math Scores from this year
Participant’s test scores
Does the participant have any special health issues?
Yes
No
If yes, what special health issues?
Is the participant allergic to anything?
Yes
No
If yes, what allergies?
Emergency Contact Name
Emergency Contact Telephone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
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