Summer Youth Program Application Form Template

Summer Youth Program Application Form

Please complete the form below to provide essential information for your child’s enrollment.

Participant Information

Name

Date of Birth

Age

Gender

Male
Female

Address

Guardian's Name

Phone number

Health Information

Does the participant have any allergies?

Does the participant have any medical conditions we should be aware of?

Is the participant taking any medications?

Physician's Name

Phone number

Program Participation and Consent

Liability Waiver and Release

I, the undersigned, as the parent/guardian of (participant’s name), acknowledge that participation in the summer program is voluntary. I agree to hold harmless the program organizers, staff, and associated parties from any and all liability related to injuries or damages incurred during program activities.

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