YHBD 2026 Summer Camp Registration Form

Thank you for your interest in our 2026 Summer Arts Camp!

Camp Name: Young Hearts Big Dreams
Camp Dates: June 22, 2026 - July 5, 2026
Camp Hours: 8:30am - 4:00pm
Eligible Participants: Students entering 6th grade - 12th grade in the fall
- Note: At this time, we are still researching options to provide the necessary accommodations for students with special needs or significant medical conditions.
Programming:
- To Be Announced Soon
Camp Location: Revealing Truth Church (5201 N. Armenia Ave. Tampa)

Student's Name

First NameLast Name

Birth Date

MonthDayYear

Entering Grade for 2026-2027 School Year

Gender

Student's T-Shirt Size:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Authorized Pick-Up

Authorized Pick-Up Person # 1

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Authorized Pick-Up Person # 2

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Does the student have any physical allergies, chronic illness, or medical conditions? If yes, please describe here (and also review the "Eligible Students" Section in the form description above):

Does the student have a food allergy or intolerance that we should be aware of? If yes, please list them here.

Is the student prescribed an inhaler? If yes, please explain any instructions.

Does the student have special needs accommodations (IEP or 504 Plan) or on the autism spectrum? If yes, please describe here (and also review the "Eligible Students" Section in the form description above)

Does this student have a sibling who is also attending the YHBD Summer Camp? If so, please list the sibling's name(s) here. (NOTE: A separate registration is required for each eligible sibling)

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Young Hearts Big Dreams & Revealing Truth Church during the selected camp. In exchange for the acceptance of said child’s candidacy by Young Hearts Big Dreams & Revealing Truth Church, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Young Hearts Big Dreams & Revealing Truth Church 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 Young Hearts Big Dreams & Revealing Truth Church, including all coaches 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 hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Young Hearts Big Dreams & Revealing Truth Church and its affiliates including Directors, Teachers, and Staff 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 registered 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.

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.

Date

Signature

2026 Summer Camp Registration

Student/Youth Information