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Career Camp-Parent Permission & Registration Form September 28th-October 2nd
Thank you for your interest in Career Camp hosted by United Way Forsyth and Dawson Counties. This camp provides students with opportunities to explore local careers through business visits, professional interaction, and hands-on learning experiences. Career Camp is designed to provide career exploration opportunities for middle school students in Forsyth and Dawson Counties.
Information:
Drop-Off Time: 8:50 AM – 9:00 AM Location: 240 Elm Street, Cumming, GA, 30040 Pick-Up Time: 12:00 PM – 12:10 PM Location: 240 Elm Street, Cumming, GA, 30040 Transportation: Students will travel by bus to and from United Way Forsyth and Dawson Counties and local business locations. Important Note: Please pick up students on time each day.
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Student Name
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
*
Please Select
Male
Female
Non-binary
Race/Ethnicity
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Other Pacific Islander
White
Multiracial
Other
School Name:
*
Grade (2026-2027 School Year)
*
Adult T-Shirt Size:
*
Please Select
XS
S
M
L
XL
XXL
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Parent/Guardian Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Does your student qualify for free or reduced-price school meals?
*
Yes
No
Has your family received assistance from any of the following programs in the past 12 months? (Select all that apply)
*
SNAP/Food Stamps
Medicaid/PeachCare
Housing Assistance
School Social Worker Support
McKinney-Vento Services
None of the Above
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Emergency Contact Information:
*
First Name
Last Name
Relationship to Student:
*
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Is your child permitted to leave the program independently (self-checkout)?
*
Yes — student may leave independently
No — student must be picked up by an authorized adult
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Authorized Pick-Up Persons
List all individuals authorized to pick up your child. Camp staff will request a valid photo ID. Only the people listed below are permitted to pick up your child.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
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Medical Information
Medications Student May Need During Camp
*
Yes
No
Allergies / Medical Conditions:
*
Yes
No
If answered yes, please explain:
Food & Refreshment Authorization-Snacks, beverages, or refreshments may be provided by United Way staff or business hosts during camp activities
*
I authorize my child to receive snacks and refreshments provided during camp activities.
My child has dietary restrictions (describe below):
Dietary Restrictions:
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Transportation Consent
Students will travel by bus or other approved transportation to and from United Way Forsyth and Dawson Counties facilities andparticipating business locations. Please initial and check the box below.
*
I authorize my child to travel by bus or other approved transportation to and from business locations during Career Camp.
Parent/Guardian Initials
*
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Behavioral Expectations & Removal Clause
Students are expected to behave respectfully toward staff, volunteers, business partners, and fellow participants at all times, including during transportation and at workplace visits. United Way Forsyth & Dawson Counties reserves the right to dismiss a participant whose behavior is unsafe, disruptive, inappropriate, or inconsistent with program expectations. Parents/guardians may be required to pick up their child immediately if necessary. No refund of the participation fee will be issued in the event of removal for behavioral reasons. By initialing below, I acknowledge and agree to the Behavioral Expectations policy:
Parent/Guardian Initials:
*
Personal Property Responsibility
United Way Forsyth & Dawson Counties is not responsible for lost, stolen, or damaged personal items, including butnot limited to phones, electronics, jewelry, clothing, or other valuables brought to camp. Students are encouraged to leavevaluables at home.
Parent/Guardian Initials:
*
Photo & Media Release
I give permission for my child to be photographed and/or recorded during Career Camp activities. I understand these photos and/or audiovisual recordings may be used by United Way Forsyth and Dawson Counties for promotional materials, social media, newsletters, or other communication purposes without compensation.
Parent/Guardian Initials:
*
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Camp Fee & Payment Information
The participation fee for Career Camp is $25 per student. Payment must be made before the start of camp. Scholarships are available if needed. Please contact Freddie Lopez at freddie@uwfd.org for assistance
Form of Payment:
Cash
Check payable to: United Way Forsyth and Dawson Counties
Card Payment: https://www.uwfd.org/donate — include note: Career Camp – [Student Name] *Please do not make payment until you have received confirmation that your student has been accepted.
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Permission, Assumption of Risk, Release & Medical Authorizationg
I give permission for my child to participate in Career Camp activities, including transportation to and from local business locations. I understand that although the program involves activities generally considered educational and supervised in nature, and that reasonable efforts will be made to ensure student safety and appropriate supervision, participation may involve certain inherent risks, including, without limitation, injuries, illness, allergic reactions, and property loss. By signing below, on behalf of myself and my child, to the fullest extent permitted by applicable law, I hereby voluntarily assume all risks associated with my child's participation in the program, whether known or unknown, foreseeable or unforeseeable. By signing below, to the fullest extent permitted by applicable law, I hereby release, waive, discharge, and covenant not to sue United Way Forsyth & Dawson Counties and each participating business partner, workplace host, employee, volunteer, and affiliated representative for any claims or losses arising out of my child's participation in the program, except to the extent such claims arise from gross negligence, willful misconduct, or other conduct that cannot be released or waived under applicable law. In the event of an emergency, I authorize camp staff to seek medical treatment for my child if I cannot be reached promptly. I understand that I remain responsible for any medical expenses incurred on behalf of my child. By signing below, I confirm that I have disclosed all medical conditions, allergies, medications, dietary restrictions, physical limitations, behavioral considerations, or other information that may be relevant to my child's safe participation in the program. I understand that failure to provide accurate and complete information may affect the ability of United Way Forsyth& Dawson Counties to respond appropriately in an emergency.
Name
*
First Name
Last Name
Parent/Guardian Signature:
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Submit
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