Tiger Academy Team-Up Registration
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Email *
Please only list one student per registration. Thank you.
Student's Last Name *
Student's First Name *
Does the student have a nickname or preferred name?
What is the Student's Date of Birth? *
MM
/
DD
/
YYYY
What are the last four digits of the student's Social Security Number? *
Grade Level *
Student's Home Address *
City, State *
Zip Code *
What is your student's gender preference? *
What is your student's ethnicity? *
Required
What is the Mother's or Legal Guardian's Full Name (Last Name, First Name)
Mother's or Legal Guardian's Primary Phone Number  (XXX-XXX-XXXX) *
Is this a mobile phone number? *
What is the Father's or Legal Guardian's Full Name (Last Name, First Name) *
Father's or Legal Guardian's Primary Phone Number  (XXX-XXX-XXXX) *
Is this a mobile phone number? *
Do you give permission to receive updates, reminders, and announcements via text message using REMIND? *
Please provide any additional phone numbers to receive updates, reminders, and announcements via text message? (XXX-XXX-XXXX)
Parental Marital Status *
Annual Household Income
Clear selection
Who does the student live with? *
If you selected 'Other,' please specify:
Who is permitted to withdraw the student's enrollment in camp? *
If you selected 'Other,' please specify:
Who has legal custody of the student? *
If you selected 'Other,' please specify:
Please list siblings that also attend Tiger Academy Team UP *
Emergency Contact #1: Full Name (Last Name, First Name) *
Emergency Contact #1: Phone Number (XXX-XXX-XXXX) *
Emergency Contact #2: Full Name (Last Name, First Name) *
Emergency Contact #2: Phone Number (XXX-XXX-XXXX) *
Emergency Contact #3: Full Name (Last Name, First Name)
Emergency Contact #3: Phone Number (XXX-XXX-XXXX)
Emergency Contact #4: Full Name (Last Name, First Name)
Emergency Contact #5: Phone Number (XXX-XXX-XXXX)
Emergency Contact #6: Phone Number (XXX-XXX-XXXX)
Does your child have any chronic health problems? *
Does your child have special dietary restrictions? *
Does your child have special needs? *
Is there any additional information you may feel is important?
Does your child have health insurance? *
Would you like someone from Kids Hope Alliance/Cover Jacksonville to contact you with more information about Florida KidCare for children under 19? *
Conditions of Youth Development Program Participation
While the YMCA will make every attempt to provide reasonable accommodations for mentally and physically challenged children, the YMCA will not accept children that are (1) of danger to themselves, (2) of danger to others, or (3) a disruption to the normal activities making it unreasonably difficult for other children to enjoy YMCA programs. Any of the above reasons will be grounds for dismissal from YMCA programs. The YMCA strongly recommends that you discuss with YMCA staff any special conditions or circumstances involving your child. The YMCA requests that the undersigned do this PRIOR to registration so that the YMCA can advise you as to whether we can make reasonable accommodation for your child.

The undersigned understands that the YMCA is NOT responsible for personal property lost or stolen while members and/or program participants are using YMCA facilities or on YMCA premises.

I give permission for the City of Jacksonville, YMCA, and/or Kids Hope Alliance to access and/or use participant data, care giver data, and academic records of the participant in the designated data system or its generated reports.

I give my permission to the YMCA of Florida’s First Coast Inc. and the Kids Hope Alliance to use, without limitation or obligation, photographs, film footage or tape recordings that may include mine and/ or my family member’s image(s) or voice(s) for purposes of promoting or interpreting YMCA programs.

In the event of an emergency and my emergency contact person cannot be reached, the undersigned hereby gives his or her permission to the physician selected by the YMCA to hospitalize, secure proper treatment for, and to order injections, anesthesia or surgery for the individual named on this application.

The undersigned understands that no accident or medical insurance is provided with this activity.

The undersigned gives his or her permission for my child to be transported by the bus service secured by the YMCA for related programs activities.

Acceptance: I accept the Conditions of Youth Development Program Participation set forth above and, being in alignment with the Mission of the YMCA, hereby apply to participate. If you answer 'no' your child will be unable to attend the summer camp. *
FLORIDA MINOR RELEASE AND WAIVER OF LEGAL LIABILITY
THIS IS YOUR RELEASE AND WAIVER OF LIABILITY (the “Release”). You individually and on behalf of your minor child, release the YMCA of Florida’s First Coast, Inc. (“YMCA”), its officers, directors, board members, employees, volunteers, agents, independent contractors, other participants and/or others acting on its behalf (collectively, “YMCA”).  You agree that this Release is effective immediately.
 You agree that this Release is effective immediately. *
NOTICE TO THE MINOR CHILD'S NATURAL GUARDIAN READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF YMCA USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM [YMCA] IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND YMCA HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.
I have read the above waiver, release, and indemnification agreement: *
I understand that I must complete additional registration documents (i.e., registration form, field trip and Saftey Around Water permission forms, FERPA, and the Walker Release form, if applicable, as well as any other documents required) in order for my child to be a registered participant of this summer camp. *
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