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2025 Young & Gifted Summer Camp
Please complete a new form for each student you intend to participate. Thank you in advance.
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EVERYBODY E.A.T.S // Elevating Art Through Soul
Student’s Full Name:
*
Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Age:
*
Your answer
Address:
*
Your answer
School/Grade Level:
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Your answer
Weight/Height:
Your answer
Sex:
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Male
Female
Prefer not to say
Last Physical Date:
MM
/
DD
Allergies? If yes, please list.
Your answer
Dietary Restrictions?
Your answer
Parent/Guardian Name:
*
Your answer
Do you have insurance? If yes, please provide the carrier and the card number.
Your answer
Cell Phone Number:
*
Your answer
Email:
*
Your answer
Business Name:
Your answer
Business Address:
Your answer
Business Phone:
Your answer
Hours at work:
Your answer
Emergency contact name, relationship, and phone number:
*
Your answer
How will your child/children travel to camp? From camp?
Your answer
How did you hear about us?
Your answer
Favorite School Subjects (please list if any):
Your answer
Which school subjects are the least favorite? Check all that apply.
Math
Science
English
History/Social Studies
Does your child have any performing arts experience?
Yes
No
Maybe
Clear selection
Which art form would you say your child likes best? Check all that apply.
Act
Sing
Dance
Rap
Drawing/Painting
Graphic Design
Photo/Videography
Lights/Stage Design
Fashion
Marketing/Sales
Hoodie Size:
*
Youth Small
Youth Medium
Youth Large
S
M
L
XL
XXL
Other
Other:
T-Shirt Size:
*
Youth Small
Youth Medium
Youth Large
S
M
L
XL
XXL
Other
Other:
Check all that you would like to register for:
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Young & Gift All-Star Summer Camp (9:00AM - 4:00 PM)
Volunteer
Interns
Other:
Required
I give my child permission to attend The SouthSide Soul Youth Empowerment Program. I also agree to allow my child’s photo or likeness to be used in any advertising, press or other forms of media for Everybody E.A.T.S.
*
Yes
No
Does your child have any chronic health conditions? If yes, please explain.
*
Your answer
Are there any custody agreements, court orders, and restraining orders pertaining to your child? If yes, please explain.
Your answer
Are there any special limitations or concerns? If yes, explain.
Your answer
Please list the name, relationship, and contact information of anyone authorized people to pick up your child.
Your answer
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