Summer Teen Program Registration 2026

Teen Summer Program

Camp Restore Detroit
Please read the following information before completing this form

The Teen Summer Program is for Teens between the ages of 13-18 years old.

If you have children under 13 years or older, you can check out our SPARK summer camp for kids.

You must fill out one form for each teen you are registrating. After submitting one form you should recieve the option to fill out another form.

If you have any questions please reach out to Maisha Griswold, Director of Community Programs at 313-636-4422 ext 2 or detroit@camprestore.org
Teen Information
Teen's Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
Date
Address where Teen resides in the Summer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Teen's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Gender
T-Shirt Size
Name of School child attends or will attend in Fall 2026
Grade child is completing in the 2025-2026 school year
Teen's Ethnicity
Teen's Race
Will the Teen be attending summer school or ingenuity in the summer of 2026
Allergy Information
Please list all allergies (food, environmental, etc. . ) please indicate if the child carries on Epi-Pen for this allergy
Special Instructions
Anything we should know about your child that would help us. Any Activity restrictions, behavioral needs etc. . .
Parent / Guardian Information

Parents/ Guardians listed here will be first to be contacted should an issue arise or in case of emergency. Parents and Guardians listed her are also authorized to pick up the child(ren) from camp)
Parent / Guardian Full Name

First NameMiddle NameLast Name
Relationship to Child
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Home Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
What is your preferred way to receive updates and information about camp?

Other
Would you like to add a second parent or guardian?
Secondary Parent / Guardian Full Name

First NameMiddle NameLast Name
Secondary Relationship to Child
Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Secondary Email Address
example@example.com
Emergency Contacts/ Authorized Pick Up

Parents or Guardians above will be contacted first in the case of an emergency. Please list at least one additional person that can be contacted in the event parents/guardians cannot be reached
Emergency Contact
Permissions, and Signatures
Permission Statements
Acknowledgments
Parent / Guardian Signature
Printed Name of Parent / Guardian

First NameMiddle NameLast Name
Date Signed

MonthDayYear
Date
Should be Empty:

Teen Summer Program

Teen Information

Parent / Guardian Information

Emergency Contacts/ Authorized Pick Up

Permissions, and Signatures