• 2026 BRIGHT FUTURES SUMMER CAMP APPLICATION

    Robstown Young Futures
  • Gender:*
  • DOB:*
     - -
  • Format: (000) 000-0000.
  • Parent/Guardian Information

  • Format: (000) 000-0000.
  • Emergency Contact Information

  • Format: (000) 000-0000.
  • School Information:

  • Medical Information:

  • Format: (000) 000-0000.
  • Date of Last Medical Exam:*
     - -
  • Permission for Treatment by Doctor/Hospital:*
  • Does your family have health and/or accident insurance:*
  • Medicaid:*
  • Format: (000) 000-0000.
  • Special Needs/Health Issues:*
  • Medications:*
  • Allergies
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  • Parent/Guardian Understood Insurance Disclaimer and Permission Statement:*
  • Child has permission to be used in public relations materials:*
  • Child may participate in all activities in or adjacent to the club building:*
  • Household:

  • NOTE: This information is collected for Grant writing purposes ONLY
  • Member lives with:*
  • Annual Income Level:*
  • Is there a Member of the Household 65 years old or Older:*
  • Current Head of Household:*
  • Is there a Member of the Household Handicapped:*
  • Current Single Parent:*
  • Lives on Military Base:*
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  • Disclaimer:

  • Robstown Young Futures is not responsible or liable in any way in the event of harm or injury occurring to the member. It is agreed that the parent or guardian will not hold Robstown Young Future responsible for the welfare or whereabouts of the member. If the Parent or Guardian does file a complaint against Robstown Young Futures the Parent or Guardian agrees to pay for Robstown Young Futures' legal fees.
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  • PROGRAM PARTICIPATION CONSENT

    I am the parent or legal guardian of the child identified above. I give permission for my child to participate in programs, activities, events, field trips, recreational activities, educational programs, sports, workshops, and other activities sponsored by Robstown Young Futures.

    I understand that participation may include indoor and outdoor activities, arts and crafts, literacy programs, computer activities, recreational games, sports, leadership activities, community events, field trips, and transportation associated with approved program activities.

    ASSUMPTION OF RISK AND RELEASE OF LIABILITY

    I understand that participation in youth programs involves certain inherent risks, including but not limited to accidental injury, illness, property damage, transportation-related incidents, and other unforeseen circumstances.

    On behalf of myself and my child, I voluntarily assume these risks and release, waive, discharge, and covenant not to sue Robstown Young Futures, Dr. Edward Borchard, its officers, directors, employees, volunteers, representatives, sponsors, and agents from any claims, demands, damages, causes of action, or liabilities arising from participation in program activities, to the fullest extent permitted by Texas law.

    MEDICAL AUTHORIZATION

    In the event of an accident, illness, or emergency involving my child, I authorize Robstown Young Futures staff, volunteers, and representatives to obtain emergency medical care when I cannot be reached immediately.

    I understand that every reasonable effort will be made to contact me or the emergency contact listed above. I accept responsibility for any medical expenses incurred as a result of emergency treatment.

    TRANSPORTATION AUTHORIZATION

    I authorize my child to be transported in approved vehicles for field trips, activities, and program-related events as necessary.

    MEDIA RELEASE

    I grant permission for Robstown Young Futures to photograph, videotape, record, or otherwise capture images or recordings of my child during participation in program activities.

    I authorize Robstown Young Futures to use such images and recordings for educational, promotional, fundraising, marketing, website, social media, and other organizational purposes without compensation.

  • Type a question*
  • PARENT/GUARDIAN CERTIFICATION

    I certify that I am the parent or legal guardian of the child listed above. I have read and understand this Consent, Liability Waiver, Medical Authorization, and Media Release. I understand that by signing this document, I am agreeing to its terms on behalf of myself and my child.

     

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