ZSDA Summer Camp 2024 Registration Form
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Student's First Name  *
Student's Last Name *
Student's Date of Birth (MM/DD/YY)
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Student's Age on August 1, 2024
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Student Entering Grade in Fall 2024
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Student's Email (Gmail address only) 
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Parent/Guardian #1 Name (First and Last name) *
Parent/Guardian #1 cell phone number *
Parent/Guardian #1 email address *
Parent/Guardian #2 Name (First and Last name) *
Parent/Guardian #2 cell phone (a second separate phone number is required) *
Parent/Guardian #2 email address (a second separate email is required) *
Home Address (Number, Street Name, City, State, Zip) Please provide all information in the order requested. *
Which in-person summer camp will the student join? Read camp descriptions at https://zenithspeechdebate.com/camps-clubs-policies/
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Policies and Rules of the Academy - By putting my initials below, I certify that my student and I've read the ZSDA website (Summer Camps descriptions, Requirements, Policies, & Legal Disclosures - https://zenithspeechdebate.com/camps-clubs-policies/) and we are in full awareness and will be in full compliance of the ZSDA Program Policies and Rules. *
Communications and Medical Health - As parent/guardian of the Minor, by putting my initials below, I agree that I will promptly communicate any problems or issues associated with the Minor’s participation in the Program with ZSDA’s directors. I agree that I will promptly report and disclose to ZSDA’s directors all pertinent information concerning the Minor’s ability to participate successfully in the Program, including any and all health concerns. I further represent that my child is in good health condition and does not possess any learning disabilities or limitations that limit his/her participation in the program and in group activities. I hereby acknowledge that my child has no known medical issues that will inhibit independent learning and participating in ZSDA led learning activities. I further acknowledge my student does not require special attention, care, treatment, or medication that will require the support of ZSDA staff. *
Consent and Release of Liability - By putting my initials below, I hereby release and agree to hold ZSDA harmless from, and waive on behalf of my student, myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act by ZSDA, or that may otherwise arise in any way in connection with any services received from ZSDA.   I understand that this release discharges ZSDA from any liability or claim that my student, myself, my heirs, or any personal representatives may have against ZSDA with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from ZSDA. I also agree to be held liable for any and all damages, costs, and/or reparations to ZSDA and the host facilities for any damages caused by my child(ren). This liability waiver and release extends to all of ZSDA together with all owners, partners, and staff. *
COVID Liability Release Form - By putting my initials below, I acknowledge the contagious nature of COVID-19 and that the CDC continues to recommend preventative measures (cdc.gov). I further acknowledge that ZSDA has put in place preventative measures to reduce the spread of Covid-19. I also acknowledge that ZSDA cannot guarantee that my student or their families will not become infected with Covid-19. I understand that the risk of becoming exposed to and/or infected by Covid-19 may result from the actions, omissions, or negligence of my student and others, including, but not limited to ZSDA staff, other students, and their families. I voluntarily seek to enroll my student at ZSDA and acknowledge that I may be increasing my family’s risk to exposure of Covid-19. I acknowledge that my student must comply with all set procedures to reduce the spread while attending the summer camp. *
Photography & Videography - By putting my initials below, I agree that neither I nor my family members will take photos or videos for anything; photos may be taken only at the end-of-camp event only for personal use and will not share it on any group or public forum. Video recording is expressly prohibited of any and all ZSDA material as it impinges on copyrighted material. Doing so is expressly prohibited and may be grounds for expulsion and legal suit. ZSDA has the permission to photograph my student and if used for any promotional distribution ZSDA will hide their name to maintain their privacy. *
Fees Non-Refundable &  Non-Transferable - By putting my initials below, I understand and accept that the registration fees are non-refundable and non-transferable, and that my registration is my commitment that my student will participate in the program to the best of their ability and without discord from students or parents, and with full adherence to the Event Rules and Policies. There will be no exception made to this clause; withdrawal or removal from the program, at any time, will not be grounds for refund of money paid. Furthermore, I agree that the students will conduct themselves honorably and with integrity and will follow all of the Rules and Policies; otherwise registration will be forfeited and student will be disqualified/removed from the Academy. *
With my full legal name/signature below, I acknowledge and attest that all the aforementioned information I've provided is true and that I'm the parent/legal guardian of the student registering for the ZSDA Summer Camp.
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