Summer Camp – Shining Inspirations

Child's Name

First

Last

Age

Camp Week

June 9th – 13th, 2025 – 9:00am – 2:00pm
June 23rd -27th, 2025 – 9:00am – 2:00pm
July 7th – 11th, 2025 – 9:00am – 2:00pm
July 21st – 25th, 2025 – 9:00am – 2:00pm

Parent/Guardian's Name

First

Last

Phone Number

Email

With your permission, we would love to capture and share moments from our summer camp program to showcase our activities. Photos and videos will be used in marketing materials, including our website, social media, and flyers. Do you consent to your daughter being photographed and filmed during camp for marketing and promotional purposes of Shining Inspirations Inc. *

YES, I consent to my daughter’s picture and video being captured and shared for these purposes.
No, I do NOT consent.

I understand this summer camp program has inherent risks for child injury and as the parent/legal guardian, I acknowledge and assume the responsibility of potential injury to my child. As the parent/legal guardian, I do not hold Shining Inspirations Inc. responsible for any liabilities, judgements or damages as a result of participating in this summer camp program. I hereby release, waive, and hold harmless Shining Inspirations Inc., its owners, employees, volunteers, and affiliates from any and all claims, liabilities, injuries, damages, or losses that may arise from my child’s participation, except in cases of gross negligence or willful misconduct. I understand that Shining Inspirations Inc. is not responsible for any lost, broken or stolen items.

YES, I understand and agree.
No, I do NOT agree.

In the event of an accident, injury, or illness involving my child, I authorize the staff of Shining Inspirations Inc. to administer first aid and, if necessary, seek emergency medical treatment. I give permission for emergency medical services to be contacted if needed and authorize medical personnel to treat my child as deemed necessary. I understand that I am responsible for all medical expenses incurred.

YES, I understand and agree.
No, I do NOT agree.

Does your child have any allergies, medical conditions, or required medications?

YES – If yes, list below.
No

List your child's allergies, food allergies, medical conditions or required medications.

Phone from By

Emergency Contact Name

First

Last

Emergency Contact Phone Number

To ensure all campers have meals that meet their dietary needs and preferences, lunch will not be provided. Each camper must bring their own lunch and water bottle daily. Thank you for helping us create a safe and enjoyable camp experience!

Late Pick-Up Policy: Camp pick-up is at 2:00 pm. A 5 minute grace period will be given, and after that, a late fee of $1 per minute will be charged per child.

By signing below, I acknowledge that I have read, understand, and agree to all terms, conditions, waivers, and policies outlined in this form. I certify that I am the parent/legal guardian of the above child, and I give my full consent for my child’s participation in Shining Inspirations Inc. Girls' Empowerment Summer Camp. I understand that my electronic signature serves as a legally binding agreement to all terms stated above.

Clear Signature

Shirt Size

Total Price – Register By March 31st for $20.00 Off.

Payment Information