Summer Camp Detailed Registration Form

Sizwe Summer Camp Registration
Child's Information
Child's Name

First NameLast Name
Birth Date

MonthDayYear
Grade
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Does the child have any allergies, chronic illness, or medical conditions? If yes, please describe.
Is the child prescribed an inhaler or any medication? If yes, please explain any instructions.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Sihle Sizwe during the selected camp. In exchange for the acceptance of said child’s candidacy by Sihle Sizwe ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Sihle Sizwe and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against {Organization} . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Child Photo/ Video Consent

As Parent and/or Guardian of the named Child, I hereby give Sihle Sizwe Vineyard Organization permission to take photographs and or/ videos of my child. I grant Sihle Sizwe full rights to use the images resulting from the photograph and video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the groups aims. This will include (but not limited to), the right to use them in theor printed and online publicity, social media, press releases adn funding application
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Sizwe Summer Camp Registration

Child's Information