Summer Programs Waitlist  Form
 If a summer camp spot becomes available, we will get in touch with you using the contact details you provide in this form. If you're not available, we'll try to contact you again but if we cannot reach you in 24-48 hours, we'll contact the next in the queue.  Thank you for choosing Camp Genesis. GENESIS Summer Program Registration 2024
                                           135 Bastille Way - Fayetteville, GA 30214 -(678) 519- 3776
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GENESIS Summer Programs 2024
Parent Name *
First and last name
Child(ren) Name *
Address *
Email *
Phone number *
Emergency Contact #1 This person is also permitted to check my child out. *
Emergency Contact #2 This person is also permitted to check my child out.
Medical Release Information: List Company, Policy number, and Primary Physician *
Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures).
Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason?
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Is your child allergic to any type of food or medication? If yes, please list.
The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment. I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill.
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Photo Release: I hereby give permission for my child to be photographed during GENESIS Summer Camp. I understand the photos will be used to keep a journal of activities, to share during powerpoint presentations and/or reports for promotional purposes including flyers, brochures, newspaper and on the internet.  I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed.
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My child will enroll in the following program(s).  You can email the weeks/days you are interested in participating. *
Required
Your child's grade
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