SmartPlay Camp Registration Form

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SmartPlay Camp Registration

Camper Full Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Grade Entering(Required)

School Name

Gender(Required)

Male

Female

T Shirt Size(Required)

Parent / Guardian 1

Full Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent / Guardian 2

Full Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Email(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact 1

Full Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Emergency Contact 2

Full Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Camp Enrollment Information

Camp Sessions Registering For(Required)

Week 1: June 22 - June 26

Week 2: June 29 - July 3

Week 3: July 6 - July 10

Week 4: July 13 - July 17

Week 5: July 20 - July 24

Week 6: July 27 - July 31

Week 7: August 3 - August 7

Week 8: August 10 - August 14

Full-Day or Half-Day?(Required)

Before Care Needed?(Required)

After Care Needed?(Required)

Would you like your child to participate in academic enrichment through Time4Learning during camp hours?(Required)

What grade level would you like your child to work at during enrichment time?

2nd Grade

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

Which subject areas would you like your child to focus on?

Reading

Writing

Math

Science

Social Studies

Choose up to two subjects

Would you like your child to review previous material, stay on grade level, or work ahead?

Does your child have any learning challenges, accommodations, or special needs we should be aware of?

Is there anything you would like us to help your child improve or gain confidence in during camp?

Total

Medical

Allergies

Medical Conditions

Dietary Restrictions

Does your child require any accommodations or special support?

Authorized Pick-Up Information

Full Name(Required)

First Last

Relationship to Camper(Required)

Phone(Required)

Full Name

First Last

Relationship to Camper

Phone

Full Name

First Last

Relationship to Camper

Phone

Consent & Payment

Camp Participation Agreement(Required)

I Agree

I give permission for my child to participate in all camp activities, including sports, recreation, enrichment, games, and field trips unless otherwise noted.

Medical & Emergency Authorization(Required)

I Authorize

I understand that participation in camp activities, including sports, games, recreation, enrichment, and physical activity, may involve the risk of injury. I voluntarily allow my child to participate and accept these risks.

Behavior Policy(Required)

I Agree

I understand that my child is expected to follow all camp rules, directions, and behavior expectations while attending camp.

Dismissal Policy(Required)

I Understand

I understand that unsafe behavior, bullying, repeated misconduct, or failure to follow camp rules may result in dismissal without refund.

Pickup Authorization Policy(Required)

I Agree

I understand that only authorized individuals listed on this form may pick up my child unless written approval is provided.

Late Pickup Policy(Required)

I Understand

I understand that additional fees may apply if my child is picked up after their scheduled dismissal time.

Personal Property Policy(Required)

I Understand

I understand that AdvantagEDU LLC are not responsible for lost, stolen, or damaged personal belongings.

Photo & Media Release(Required)

I Consent

I consent to the use of photos, videos, or recordings of my child for camp, website, promotional, and social media purposes unless I provide written notice opting out.

Payment & Refund Policy(Required)

I Understand

I understand that registration fees, deposits, and camp payments may be nonrefundable except as stated in camp policies.

Release of Liability(Required)

I Agree

I release and hold harmless AdvantagEDU LLC, its staff, contractors, volunteers, affiliates, and facility partners from claims, injuries, damages, or losses arising from my child’s participation, except in cases of gross negligence or intentional misconduct.

Information Accuracy(Required)

I Certify

I certify that all information provided in this registration form is true, complete, and accurate to the best of my knowledge.

Total

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