Summer Day Brain Boost Camp Registration Form

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Summer Day Brain Boost Camp Registration Form

Please fill out the form below to register for our Summer Day Brain Boost Camp.

Registration Options $50 Pay Now to complete your registration or join our fundraiser and meet your goal by May 22nd. (Note* There are no refunds)

Email *

Participant Information

First Name *

Last Name *

Age
*

Gender
*

Male

Female

Prefer not to say

Parent/Guardian Name
*

Parent/Guardian Contact Number
*

Parent/Guardian Email Address
*

Are there any days that your child will miss during summer camp? If yes, please list the days.

Emergency Contact Information

Emergency Contact Name
*

Emergency Contact Number
*

Medical Information

Does the participant have any allergies or medical conditions we should be aware of? If yes, please provide details:

Does the participant have any dietary restrictions? If yes, please provide details:

Additional Information

How did you hear about our Summer Day Brain Boost Camp?

Is there anything else you would like us to know or any special requests?

Confirmation

By submitting this form, I confirm that the information provided is accurate and I agree to abide by the rules and regulations of the Summer Day Brain Boost Camp.

Waiver and Release

I, hereby acknowledge that I wish to voluntarily participate in activities and programs organized and hosted by the Avengers Youth Mentoring Organization (AYMO) located in Detroit, Michigan, and Houston, Texas.

In consideration of being permitted to participate in these activities, I hereby release, waive, discharge, and covenant not to sue AYMO, its directors, officers, employees, agents, and volunteers from any and all liability, claims, demands, actions, and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me or to any property belonging to me, whether caused by the negligence of AYMO or otherwise, while participating in such activities.

I am fully aware of the risks and hazards involved in participating in AYMO activities and programs, including but not limited to physical injury, illness, or death, and hereby elect to voluntarily participate. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury, including death, that may be sustained by me or any loss or damage to property owned by me as a result of being engaged in such activities.

I understand that AYMO does not provide any insurance coverage for participants and I am responsible for obtaining my own medical, health, and accident insurance coverage while participating in AYMO activities and programs.

I further agree to indemnify and hold harmless AYMO from any loss, liability, damage, or costs, including court costs and attorney's fees, that may occur as a result of my participation in AYMO activities and programs.

I have carefully read and fully understand the contents of this Waiver and Release Form, and I voluntarily sign it of my own free will.

Electronic Signature

First Name *

Last Name *

Date of Birth *

YYYY

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