HOUSTON SUMMER CAMP
Complete the form below to register your child for our summer camp. Summer camp is from Monday, June 20, 2022 - Friday, July 29, 2022.
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Email *
Child First Name *
Child Last Name *
Child Age *
Child Pronoun *
Address *
City *
State *
Zip *
Phone Number *
List of any known allergies (If none type N/A) *
Does your child take any medications? *
If yes to the above question, what are they?
In the event of an emergency, what hospital would you like your child to go to?
Parent/Guardian First Name *
Parent/Guardian Last Name *
Emergency Contact information *
Waiver
In the event the AVENGERS YOUTH MENTORING ORGANIZATION is asked to participate in any of the following, my child may participate in all television filming, newspaper interviews, movies, film commercials and questionnaires. I have no objection to my child being included in photographs, slides or movies taken during events which might be used for purposes of interpreting, marketing, promoting and publicizing the AVENGERS YOUTH MENTORING ORGANIZATION or this particular tour. ALL PARTICIPANTS AND THEIR PARENTS AND/OR GUARDIANS, AGREE TO INDEMNIFY, PROTECT AND HOLD HARMLESS AND DEFEND THE AVENGERS YOUTH MENTORING ORGANIZATION, ITS AGENTS, AND EMPLOYEES FROM AND AGAINST ALL LOSSES, COSTS, DAMAGES AND LIABILITY WHATSOEVER AND ALL RELATED EXPENSES, INCLUDING COSTS ATTORNEY FEES, WHETHER WITH OR WITHOUT MERIT, FOR DAMAGES BECAUSE OF BODILY INJURY, SICKNESS, DISEASE OR DEATH AT ANY TIME RESULTING FROM, ARISING OUT OF OR IN ANY WAY IN CONNECTION WITH PARTICIPATION IN AVENGERS ACTIVITIES. Furthermore, I understand that there are no refunds. I have read this agreement, fully understand its terms and have signed it freely and without inducement.
(Please sign below using your first and last name . You must also include your date of birth to confirm electronic signature.) *
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