Camp Destination Innovation 2024 Registration

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Registration Form - Please complete.

Please be aware that your registration form is not complete until $40 camp fee is made through paypal. Link below.

Camp starts June 11th - June 28th 9:00 am - 2:30 pm

Please email campdiwichita@gmail.com if you have any questions or concerns.

Email *

Name of Camp Participant: *

Participant's pronouns *

Age: *

Birthday: *

YYYY

Race/Ethnicity: *

Native American

Asian

Black/African-American

Hispanic

White/Caucasian

Other:

Parent/Guardian Name(s): *

Guardian Phone Number: *

Address: *

Please list any other information that you think would be valuable for the Camp Destination Innovation staff to be aware of: *

Release of Liability

I hereby release and hold harmless Camp Destination Innovation, Destination Innovation Inc, and all of its officers, employees, agents, representatives, volunteers, heirs, executors, and assigns from all liability personal injury including death, as well as property damage or loss arising out of my child's participation in this Camp program, whether paid for by myself or Camp Destination Innovation. I understand that this releases liability from the conduct of Camp Destination Innovation and its officers, employees, agents, representatives, volunteers, heirs, executors, and assigns.

Parent/Guardian Signature *

By entering your name, you consent to the release of liability.

Photo Release

The undersigned gives permission to Destination Innovation to use photographs and audio and/or video recordings of the Camp Destination Innovation participant for fundraising and/or marketing purposes. On occasion, participant photographs may be included in promotional videos, websites, albums, newsletters, or our information bags. Camp Destination Innovation respects the privacy of camp participants and will not allow unauthorized visitors to photograph or video the camp or its participants.

Parent/Guardian Signature *

By entering your name, you consent to our photo release.

Participant Consent

The undersigned consents to participate in all activities, including transportation (if needed, to and from camp activities).

Parent/Guardian Signature *

By entering your name, you agree to the participant consent.

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