Summer Camp at Good News Church Participant Information and Registration

Child's Name

Full Name *

T shirt size (XS,S,M,L) *

Grade *

Child 2 (If Applicable)

Full Name

T shirt size (XS,S,M,L)

Grade

Child 3 (If Applicable)

Full Name

T shirt size (XS,S,M,L)

Grade

What Elementary School does your Child/ren Attend? *

Early Bird Special Expires 4/15 Coupon Code: Summer23

Week 1 Camp June 26th-30th

Select all that apply:

June 26th- 30th $250

June 26th- 30th Second Child

June 26th- 30th Third Child

Week 2 Camp July 5th-7th (Short Holiday Week 3 days)

Select all that apply:

July 5th- 7th $150

July 5th- 7th Second Child

July 5th- 7th Third Child

Please don't forget to enter the coupon code below to get your. EARLY BIRD DISCOUNT

Early Bird Special Expires 4/15 Coupon Code: Summer23

Enter Coupon Here

Current Total:

$0.00

Adult Primary Contact 1

Relationship to Participants: *

Parent

Guardian

Other Other

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Email *

Adult Primary Contact 2

Relationship to Participants:

Parent

Guardian

Other Other

First Name

Last Name

Address 1

Address 2

City

State

Zip

Phone

Email

Emergency Contact

Emergency Contact 1 *

Phone *

Emergency Contact 2

Phone

Primary Care Pediatric Contact

Doctor's Name *

Phone *

Does your child have any allergies? (N/A for none)

Sports and Arts Participation Waiver

Parent or legal guardian must sign below before acceptance into program:

As parent/legal guardian of the child named herein, I hereby represent that the child has been deemed physically fit by his/her pediatrician to participate in Sports instruction. I understand that there are inherent risks in participating in this athletic program.

I hereby accept responsibility for and agree to pay any and all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation in all physical activities with Sports & Arts.

I understand that all enrollments are final and no refunds will be issued once payment is made. However, if there is an unforseen emergency funds can be prorated to another future Sports-and-Arts program.

I further agree to indemnify and hold harmless Sports & Arts LLC and any of their coaches from any and all liability, damage, cost or expense arising out of my child's participation of every kind and nature.

In the event that I cannot be reached in an emergency, I hereby give permission for the care to be administered by Sports & Arts staff, EMT, physician / staff of hospital or any other qualified individual to provide medical treatment deemed necessary for my child.

I give permission to communicate with me via text and email and to take pictures and/or videos of my child for Sports and Arts website and marketing purposes.

Please print name below: *

Please Sign Below: *

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Sports and Arts Covid Waiver

Parent or legal guardian must sign below before acceptance into program: I agree to release Sports and Arts LLC and its Employees from any and all liability for the unintentional exposure or harm due to the Coronavirus (COVID-19). Furthermore, I understand that my name and contact information might be shared with the state health department if a client or person at this facility tests positive for COVID-19. My contact details will only be shared in the event they are relevant based on suspected exposure date, and only for appropriate follow-up by the health department.

Print Name *

Signature *

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HERITAGE LANDING Summer Camp Waiver

Signature *

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Summer Camp at Good News Church Participant Information and Registration

Child's Name

Child 2 (If Applicable)

Child 3 (If Applicable)

Early Bird Special Expires 4/15 Coupon Code: Summer23

Week 1 Camp June 26th-30th

Week 2 Camp July 5th-7th (Short Holiday Week 3 days)

Please don't forget to enter the coupon code below to get your. EARLY BIRD DISCOUNT

Early Bird Special Expires 4/15 Coupon Code: Summer23

Adult Primary Contact 1

Adult Primary Contact 2

Emergency Contact

Primary Care Pediatric Contact

Sports and Arts Participation Waiver

Sports and Arts Covid Waiver

HERITAGE LANDING Summer Camp Waiver

Payment