Minds of the Future Summer Camp Application

Camper's Full Name

First NameLast Name

Date of Birth

Date

Gender

Grade Level

Camper T-Shirt Size

Parent/Guardian Name

First NameLast Name

Parent/Guardian Email

example@example.com

Parent/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relation to Camper

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relation to Camper

Liability and Release of Claims: I, the undersigned parent/legal guardian of the participant listed below, acknowledge that participation in the summer camp program hosted by Minds of the Future Academy may involve physical activities, transportation, recreational activities, field trips, and other activities that may carry inherent risks. I voluntarily permit my child to participate in all approved camp activities and assume all risks associated with participation. I hereby release, waive, discharge, and hold harmless Minds of the Future Academy, its officers, employees, volunteers, contractors, and affiliates from any and all liability, claims, demands, actions, or causes of action arising out of injury, illness, loss, or damage that may occur during participation in camp activities, except in cases of gross negligence or intentional misconduct. I understand that camp staff will take reasonable precautions to ensure participant safety and that rules and expectations must be followed by all participants.

MEDICAL TREATMENT AUTHORIZATION: I authorize Minds of the Future Academy staff, volunteers, and authorized representatives to obtain emergency medical treatment for my child if I cannot be reached immediately in the event of an emergency.I understand that every reasonable effort will be made to contact me prior to treatment. I accept responsibility for any medical expenses incurred.Signature

Please list any allergies or medical conditions (N/A for none)

Photo & Media Release: I grant permission for Minds of the Future Academy and Protective Enterprises Public Safety to photograph, video record, and/or use images or recordings of my child for educational, promotional, marketing, website, social media, and public relations purposes without compensation.I understand that names may or may not be used alongside photographs or recordings.

TRANSPORTATION PERMISSION & BEHAVIOR AGREEMENT: I give permission for my child to be transported by authorized camp personnel for approved camp activities, educational trips, recreational outings, and emergency situations when necessary. I understand transportation may occur via school van, bus, contracted transportation, or approved staff vehicles where permitted by law and policy.I acknowledge that safety procedures and supervision will be maintained during transportation activities.

Code of Conduct Agreement: To ensure a safe, respectful, and enjoyable environment for all participants, campers are expected to: • Treat staff, volunteers, and fellow campers with respect• Follow all instructions and safety rules• Use appropriate language and behavior at all times• Respect camp property, equipment, and facilities• Refrain from bullying, fighting, harassment, or disruptive conduct• Remain with assigned groups unless authorized otherwise• Follow transportation and field trip expectations The following behaviors may result in disciplinary action, suspension, or dismissal from camp:• Physical aggression or threats• Possession of prohibited items• Repeated disrespectful behavior• Unsafe conduct• Destruction of property I understand that failure to follow camp rules may result in my child being removed from activities or dismissed from camp without refund if applicable.