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Summer Camp 2023
Registration is now available and closes June 16.
Summer Camp 2023
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Student Information
Student Name
*
First
Last
Gender
*
Male
Female
Non-binary
Prefer not to answer
Date of Birth
*
Month
Day
Year
Student's Home Address
*
Street Address
Address Line 2
City
State
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Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
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Indiana
Iowa
Kansas
Kentucky
Louisiana
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Maryland
Massachusetts
Michigan
Minnesota
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Montana
Nebraska
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New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Please list any allergies or special considerations for your student.
Grade Entering in Fall 2023
*
Kindergarten
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
11th
12th
T-shirt Size
*
Youth S
Youth M
Youth L
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
1st Choice Activity
*
Football
Basketball
Music
Golf
Crafts
Soccer
2nd Choice Activity
*
Football
Basketball
Music
Golf
Crafts
Soccer
3rd Choice Activity
*
Football
Basketball
Music
Golf
Crafts
Soccer
Parent/Guardian Information
Parent/Guardian Name
*
First
Last
Phone
*
Email
*
Emergency Contact
*
First
Last
Emergency Phone
*
Consent
*
*I understand that while participating at Streams of Hope that my child is expected to conduct him/herself in an orderly manner. They are expected to respect the instructor and other students.
*I understand that if my child’s behavior/attitude is disruptive, they will risk removal from the program.
*I am the legal parent/guardian of this student and do hereby consent and allow Streams of Hope, Grand Rapids, MI to handle any type of medical care for my child including but not limited to the administration of anesthesia determined by a physician to be necessary for the welfare of my child while said child is in the care of Streams of Hope and I am not reasonably available by telephone to give consent.
*I also hereby grant permission to Streams of Hope and its representatives to take photographs or videos of me, and/or my child while at Streams of Hope located at 280 60th St SE, Grand Rapids, MI 49548. I further grant producers and their representatives the right to reproduce, use, exhibit, display, broadcast, distribute and create derivative works of these images and recordings in any media now known or later developed. I acknowledge that Streams of Hope owns all rights to the images and recordings.
*I hereby waive any right to inspect or approve the use of the images or recordings or of any written copy. I also waive any right to royalties, or other compensation arising from or related to the use of the images, recordings, or materials. I hereby release, defend, indemnify, and hold harmless the producers from and against any claims, damages, or liability arising from or related to the use of the images, recordings, or materials, including but not limited to claims or defamation, invasion of privacy, or rights of publicity or copyright infringement, or any misuse, distortion, blurring, alteration, optical illusion or use in composite form that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
I consent.
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