STUDENT'S NAME

First Name

Last Name

GRADE *

7

8

9

10

11

PARENT/GUARDIAN NAME *

First Name

Last Name

Phone

(###)

###

####

HOME ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Does the participant have any allergies? *

YES

NO

Does the participant have any medical conditions? *

YES

NO

Is the participant currently taking any medications? *

YES

NO

Does the participant have any dietary restrictions? *

YES

NO

Does the participant have any disabilities or mobility issues? *

YES

NO

Photo/Video Consent *

As part of our camp activities, we may take photographs and videos of the participants for promotional purposes. To ensure the privacy and safety of all children, we require explicit permission for the use of your child's image. Permission MUST BE GIVEN for your child's photo/video to be used for promotional purposes. These images and videos will be utilized solely for educational and higher learning promotions connected with Jamecia Bennett in association with the bootcamp. We are committed to maintaining the confidentiality and safety of all minors involved.

YES I understand and give permission for my child’s photo/video to be used for promotional purposes.

SAFETY *

Safety is paramount for Bennett's Bootcamp, and ensuring a secure environment is everyone's responsibility. We are dedicated to providing a safe and enjoyable experience for all participants in our summer camp. However, we want to ensure you are aware that participation in camp activities may involve some inherent risks. By signing below, I acknowledge that I understand and accept the potential risks associated with camp activities. I agree to assume full responsibility for any injuries or damages that may occur. I understand that the camp staff will take all necessary precautions to ensure the safety and well-being of all participants. Furthermore, I acknowledge the following: • Minneapolis Public Schools is not liable for any injuries or damages that may occur during camp activities. • All children will be supervised by trained professional adults who have undergone thorough background checks. • We are committed to maintaining an inclusive and non-discriminatory environment where every child feels welcome and valued. Medical Release and Emergency Contact Information: In the event of an emergency, I authorize the camp staff to seek medical treatment for my child. I understand that every effort will be made to contact me or the emergency contact provided below before any treatment is administered. Thank you for your understanding and cooperation in helping us create a safe, inclusive, and fun environment for everyone.

I AGREE