BIG KENT'S YOUTH SUMMER FITNESS CAMP
Parent Registration Form — 8-Week Summer Strength & Confidence Program | Ages 8-14
Section 1: Parent Information
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Mother
Father
Guardian
Other
Phone Number
*
-
Area Code
Phone Number
Email Address
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Section 2: Child Information
Child Full Name
*
First Name
Last Name
Child Date of Birth
*
-
Month
-
Day
Year
Date Picker Icon
Child Age
*
Gender
*
Male
Female
Prefer not to say
Current Grade Level
*
Please Select
2nd
3rd
4th
5th
6th
7th
8th
9th
School Attending
*
T-Shirt Size
*
Please Select
Youth Small
Youth Medium
Youth Large
Adult Small
Adult Medium
Adult Large
Adult XL
Section 3: Health Information
Medical Conditions (write 'None' if none)
*
Allergies (write 'None' if none)
*
Injuries or Physical Limitations (write 'None' if none)
*
Current Medications (write 'None' if none)
*
Doctor Name (Optional)
Doctor Phone Number (Optional)
-
Area Code
Phone Number
Section 4: Fitness / Sports Background
Does your child currently participate in organized sports?
*
Yes
No
If yes, which sports?
Fitness Goals (select all that apply)
*
Confidence
Get Stronger
Speed
Weight Loss
Athletic Performance
Make Friends
Discipline
General Fitness
Section 5: Camp Selection
Program Selected
*
8-Week Summer Camp (Ages 8-14)
Preferred Training Time
*
Morning
Afternoon
Evening
Section 6: Waiver / Agreement
Please read and acknowledge each statement below.
I understand that physical activity carries inherent risks, and I voluntarily accept those risks on behalf of my child.
*
I agree
I confirm my child is medically able to participate in this program.
*
I agree
I authorize Big Kent's Strength & Fitness to seek emergency medical treatment for my child if necessary.
*
I agree
I grant Big Kent's Strength & Fitness permission to use photos and videos of my child for marketing purposes.
*
I agree
I acknowledge and accept Big Kent's refund policy.
*
I agree
Section 7: Parent Signature
TYPE YOUR FULL LEGAL NAME
*
Today's Date
*
-
Month
-
Day
Year
Date Picker Icon
Optional Add-Ons
Select any add-ons you're interested in. We'll follow up with details.
Add-Ons (select any you're interested in)
Nutrition Guide for Parents
Camp Shirt Add-On
Before & After Performance Testing
Text Message Updates
Parent Newsletter
Submit Registration
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