Summer Enrichment Camp Registration Form

Summer Enrichment Camp Registration Form
About the Program

Legacy Builders Impact Foundation is a faith‑based nonprofit organization dedicated to empowering youth and helping them grow in confidence, creativity, and character. During our 3‑day Summer Enrichment Camp, children will enjoy a fun and engaging mix of crafts, hands‑on age appropriate science labs, and academic enrichment activities designed to spark curiosity and support learning. The camp will be held July 14 - July 16th, from 10am - 2pm. This event is open to school‑aged youth ages 5–12, and we look forward to providing a safe, uplifting, and inspiring experience for every child. Please contact us at 214-546-7026 with any questions you may have.
Guardian 1 Name (Authorized Pickup)

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
(optional)
Guardian 2 Name (Authorized Pickup)

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail
(optional)
Address

Street Address

Street Address Line 2

CityState

Zip Code
Child Name

First NameLast Name
Child's Birth Date

MonthDayYear
Child's Gender
Grade Level Child is Entering
Child Allergies, Medications and/ or Special Needs
If not full-time, please indicate preferred schedule.
Please select the days your child will attend. Snack will be provided, but your child may bring a peanut free lunch or snack if they would like.
I understand that my child’s participation in the Legacy Builders Impact Foundation Summer Enrichment Camp at The General Assembly Church of the Living God may involve physical activity, crafts, science experiments, and other enrichment activities. I acknowledge that these activities carry some risk of injury. I give permission for camp staff to administer basic first aid if needed and to contact emergency medical services should a more serious situation arise. I agree that I am responsible for any medical expenses resulting from such care. By signing below, I release and hold harmless Legacy Builders Impact Foundation, The General Assembly Church of the Living God, P.G.T and all staff, volunteers, and representatives from any liability, claims, or demands related to my child’s participation in this program. I understand that reasonable safety measures will be taken and agree that I am responsible for any medical expenses resulting from injury or illness.
I understand that my child’s participation in the Legacy Builders Impact Foundation Summer Enrichment Camp at The General Assembly Church of the Living God may involve physical activity, crafts, science experiments, and other enrichment activities. I acknowledge that these activities carry some risk of injury. I give permission for camp staff to administer basic first aid if needed and to contact emergency medical services should a more serious situation arise. I agree that I am responsible for any medical expenses resulting from such care. By choosing “Yes” below, I release and hold harmless Legacy Builders Impact Foundation, The General Assembly Church of the Living God, P.G.T and all staff, volunteers, and representatives from any liability, claims, or demands related to my child’s participation in this program. I understand that reasonable safety measures will be taken and agree that I am responsible for any medical expenses resulting from injury or illness.
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Summer Enrichment Camp Registration Form

About the Program