Already Registered
If you're already registered, you can just use this to let us know which field trips your child(ren) are joining us for. If this is new for you, fill the whole thing out.
The waiver at the bottom is a required field each time.
Field Trips
Check all of the trips you are certain your child(ren) will attend. If you're not sure, you can fill this out week by week.
Parent or Guardian Name
*
First Name
Last Name
Cell Phone
*
(###)
###
####
Email Address
Interested in...
Middle School Student Interested in JV Program
First Name
Last Name
Child 1
First Name
Last Name
Child 1: Date of Birth
MM
DD
YYYY
Child 2
First Name
Last Name
Child 2: Date of Birth
MM
DD
YYYY
Child 2: Last Grade Completed
Kindergarten
First
Second
Third
Fourth
Fifth
Child 3
First Name
Last Name
Child 3: Date of Birth
MM
DD
YYYY
Child 3: Current Grade
Kindergarten
First
Second
Third
Fourth
Fifth
Allergies, health concerns, or ability challenges
List any allergies, health concerns, or ability challenges of children which need consideration in care received and specify which child.
Emergency Contact
Must be an adult 18 years or older and different from primary Parent or Guardian listed.
First Name
Last Name
Emergency Contact Cell Phone
(###)
###
####
Does your child/children have permission to walk home from camp?
Additional comments concerning your child/children's care
Waiver of Liability
*
I hereby release and hold harmless Summer in the City, its officers, directors, and employees, from all claims for injury and damage of any kind resulting from my participation in Summer in the City. I understand that this Release discharges Summer in the City to the fullest extent allowed by law from any liability or claim that may be made against Summer in the City whether caused by Summer in the City or its officers, directors, employees, agents or otherwise.
I understand that there are unavoidable risks attendant to the types of activities in which Summer in the City engages and the project sites at which those activities take place. I hereby expressly and specifically assume the risk of injury or harm in these activities and release Summer in the City from all liability for injury and damage resulting from the activities of my participation. I hereby release and forever discharge Summer in the City and its representative and agents from any claim whatsoever which arises or may hereafter arise on account of any first aid, treatment or service rendered or authorized in connection with my activities with Summer in the City.
Permission for photographs and video recordings to be taken of me is granted. Further, my rights, title, and interests in all photographic images and video recordings are granted to Summer in the City.
In the event that a claim was to be pursued, I do expressly waive rights to trial by jury under state and federal law and agree to submit any matter to binding arbitration. At arbitration, I would choose an arbitrator, Summer in the City would choose an arbitrator, and the two arbitrators would select a neutral third arbitrator to decide any and all claims, actions, or disputes that could arise out of my participation with Summer in the City.
This Release is entered into knowingly, willingly and deliberately and is signed in consideration of my being able to participate in Summer in the City. No modification to this form will be given effect without the express consent of Summer in the City.
Parent/Guardian Signature
*
