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RESQ Summer Camp 2026 - Student Registration
RESQ Summer Program Registration

Join us for an 8-week summer program designed to keep middle school students (incoming 7th and 8th graders) and incoming freshmen engaged through hands-on workshops, exciting field trips, and meaningful mentorship.

Eligibility Requirements

To participate in the RESQ Summer Program, students must:

  • Be an incoming 7th grader, 8th grader, or 9th grader (freshman)
  • Be available to attend sessions on Tuesdays and Thursdays throughout the full program duration
  • Commit to consistent attendance and active participation
  • Have a completed registration form and required consent forms submitted
  • Be currently enrolled in RESQ services, as this program is intended to support students with school re-engagement, mentorship, and attendance improvement needs

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Student Information
Student Full Name *
School Name (2026 - 2027 School Year) *
Grade Level (2026 - 2027 School Year) *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Parent/Guardian Information
Parent/Guardian Full Name *
Relationship to Student *
Phone Number *
Email Address *
Emergency Contact Full Name *
Emergency Contact Phone Number *
RESQ Program Status
  Is the student currently enrolled in RESQ services?   *
  Assigned RESQ Campus Mentor   *
  Brief reason for referral/support (optional but helpful)
(ex: attendance, behavior, academic support, re-engagement)
Attendance Commitment
I understand this is an 8-week program and commit to my student attending consistently on Tuesdays and Thursdays. *
Required
  Are there any known schedule conflicts?   *
Medical Information
For the safety and well-being of all participants, we ask that you provide accurate medical information for your student. This helps our staff respond appropriately in case of an emergency and ensures students receive the support they need during the program. Please include any medical conditions, allergies, medications, and relevant doctor or insurance information. All information provided will be kept confidential and used solely for the purposes of student safety and care during the RESQ Summer Program.  
  Does the student have any medical conditions?   *
Permission and Consent
This section asks for parental/guardian consent to allow your child to participate fully in the RESQ Summer Program, including workshops, field trips, and any program-related activities. It also covers the use of photos/media and acknowledges responsibility for safety, including transportation. Please review carefully.
Field Trip Permission: I give permission for my child to participate in all off-site field trips as part of the RESQ Summer Program.   *
Photo/Media Consent: I give permission for photos or videos of my child to be used for RESQ Program purposes, including social media, newsletters, and grant reporting.   *
Liability Waiver / Acknowledgment of Risk:  I understand that my child will participate in activities that may involve physical movement, transportation, and other risks. I release Just Us 4 Youth and its staff from liability in case of injury, except in cases of negligence.     *
  I, [Parent/Guardian Full Name], provide my consent for my child to participate in the RESQ Summer Program and agree to all permissions, consents, and program policies as described above.  

Type full name below:
 *
  I confirm all information provided is accurate.   *
Required
 I understand communication will be sent via phone/email.   *
Required
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