Citizens Akron Summer Camp Registration
Event Timing: June 3-7, 2019; 9:00 AM - 3:00 PM
Who: All students Entering Grades 2nd - 7th
Event Address: Mason Park Community Center, 700 E. Exchange Street, Akron, OH 44306
Contact us at leah@citizensakron.com
Student's First and Last Name *
Your answer
Student's Grade Level (as of 2019-2020 school year) *
Your answer
Student's Age *
Your answer
Home Address
Your answer
Parent/Guardian Name *
Your answer
Phone number of Parent/Guardian *
Your answer
Emergency Contact (Other than Parent/Guardian) *
Your answer
Emergency Contact's Phone Number *
Your answer
List any allergies, medical conditions, or special learning needs. *
Your answer
Out of the following options, which Activity Track does your child wish to participate in during camp? Please list in order of greatest to least interest. Each track is limited to 15 students, so it may be necessary to place child into a secondary or third choice. The Activity Track options are as follows: Art; Soccer; Bucket Drumming *
Your answer
I give consent for summer camp staff to seek medical attention for my child if necessary. *
Required
I give consent for a licensed, insured driver from summer camp staff to transport my child to and from off-site activities.
I give consent for my child's photo to be taken by camp staff members for promotional reasons *
By clicking the following "Yes" box, I agree to, in the event of injury or property damage, hold harmless Citizens Akron, camp counselors, pastors, official staff and volunteers, and the individual members thereof, from any liability, lawsuit, cost, expense, or claim of any type whatsoever (including legal fees). *
Required
By typing my (parent/guardian) full name below, I hereby attach my signature to certify that all information given in this registration form is correct. *
Your answer
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