Summer Enrichment Camp Registration
Dates: June 11th to July 27th
Days: Every Tuesday, Wednesday, and Thursday for 7 weeks
When: 9am-3pm Tuesday-Thursday
Focus on: Cultural Education, Creative Arts Activities, Physical Exercise, Sports, Mental Health, Critical Thinking Activities, Financial Literacy, Field Trips, Educational Exposure Opportunities, and Guest Speaker Engagements
Contact: Jerome Moss, Executive Director (330)351-4482 or email at ggcpinc7@gmail.com
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Child's First Name *
Child's Last Name *
Address (Include Zip) *
Child's Birthdate *
Child's Age *
Child's School *
Child's Shirt Size *
*
Parent's First and Last Name *
Parent's Phone Number *
Best Contact Number *
2nd Best Contact Number *
Email *
Emergency Contact Name *
First and Last Name of Authorized Person to Pickup Child: Your child will only be released to a parent/guardian or
persons listed in this section Staff will require a government-issued identification before
releasing your child.
*
Pick Up Person's Relation to Child *
Cell Number *
Work Number *
Home Number *
Check to agree- Please Note: If there are any custody issues involved with your child, you must provide GGCP
INC with court papers including who has permission to pick up the child. 
*
Required
I agree to the following terms: In consideration of being allowed to participate in the GGCP INC Summer Enrichment Program (which includes athletic sports programming, educational programming, skill building programming, and related events and activities) the undersigned acknowledges, appreciates, and agrees that:
1. By participating in our Summer Camp, participants agree to allow the Guys and Gals
Community Partnership Inc summer camp committee to use photographs, video tapes, and
testimonials of participants for use in publicity materials free of any fee or usage charge. I
have read, understand, and agree to abide by the above-mentioned policies and practices.
2. The risk of injury from the activities involved in this program is significant, including the
potential for permanent paralysis and death, and while particular rules, equipment, and
personal discipline may reduce this risk, the risk of serious injury does exist.
3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF
ARISING FROM THE NEGLIGENCE OF THE RELEASES or others and assume full
responsibility for my participation.
4. I willingly agree to comply with the stated and customary terms and conditions for
participation. If, however, I observe any unusual significant hazard during my presence or
participation, I will remove myself from participation and bring such to the attention of the
nearest official immediately.
5. I, for myself and on behalf of my beneficiaries, personal representatives and next of kin,
HEREBY RELEASE AND HOLD HARMLESS 4th Annual GGCP INC Summer Enrichment Camp
and their officers, officials, agents, and/or employees, other participants, sponsoring
agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to
conduct the event ("RELEASES"), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY
DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE
NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. FULLY
UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY
SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
*
Parent's Guardian: Type your First and Last Name to Sign *
Date Signed *
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Child's Full Name: Type your First and Last Name to Sign
*
Date Signed *
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