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Parent/Guardian *

Youth Name *

Youth Age *

Email *

Phone Number *

Emergency Contact *

Emergency Contact Phone Number *

Medical/Allergy Notes *

I give permission for my child to participate in Van Isle Mind & Motion camp activities including sports, games, and physical activity. *

Yes
No

I understand that sports and physical activity involve risks such as falls, collisions, and injuries. *

Yes
No

I give permission for photos or videos of my child to be used for Van Isle Mind & Motion promotional purposes. *

Yes
No

I confirm I am the parent/guardian and agree to the Van Isle Mind & Motion participation waiver. *

Yes
No

I authorize staff to seek medical care for my child in an emergency if I cannot be reached. *

Yes
No

Program Registration