SSF Summer Camp Program (VA)
This form is for those interested in the online summer camp program. We ask that you kindly fill out the form with the necessary information needed to conduct the classes. We will schedule class times with parents once classes fill up. If you have multiple children participating please fill out the form individually for each child.
Full Name of Participant
Grade (2020-2021 school year)
Session Participating In
Session 1 (July 13-19)
Session 2 (July 20-26)
Class(es) Participating In
Arts & Crafts
Student Phone Number (if applicable)
Parent Full Name
Preferred Parent Phone Number (Whatsapp contact)
Preferred Parent Email
How Did You Hear About Us? (Friends/family, Whatsapp, email list, social media, etc)
Liability Waiver Accepted by Parent
By saying yes below, I hereby waive, release, and discharge any and all claims for damages for personal injury, property damages, or which may hereafter occur to me as a result of participation in said event. This release is intended to discharge in advance Shooting Stars Foundation Inc, its officers, student and parent volunteers from liability, even though that liability may arise out of perceived negligence on the part of persons mentioned above. I hereby give my consent to Shooting Stars Foundation to take photographs, video recordings, and/or sound recordings of me during my participation. I grant Shooting Stars Foundation my permission to use the negatives, prints, motion picture, video tapings, or any other reproduction of the same for promotional purposes on flyers, on the World Wide Web, or in any other manner deemed necessary. I expressly state that I have read, understand and am familiar with all provisions herein. I understand that this release is a contract and I sign it of my own free will. I agree to all terms and provisions herein.
Yes- I agree to the above as a parent
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