2024 Registration Form Has your child attended any of our previous events? * Such as Sustainable Me Camp 2023 or any of Change The Tune's summer programming? Yes No Camper Name * First Name Last Name Date of Birth * Grade * Gender * Male Female Parent Name * Cell Number * Home Number Email * Does the camper have any allergies, chronic illness or medical conditions? * Yes No If yes, please describe. Interested in finding out more about our sliding scale payment option and available scholarships? Financial aid options for qualifying families Yes! I'm interested in learning more. Not at this time. Thank you. Informed Consent and Acknowledgement I hereby give my approval for my child ‘s participation in any and all activities prepared by during the selected camp. In exchange for the acceptance of said child’s participation by Sustainable Me. I assume all risk and hazards incidental to the conduct of the activities, and release , absolve and hold harmless Sustainable Me, and all its respective officers, agents, and representatives from any and all liability from 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 Sustainable Me, including all coaches, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners, and lessors of premises used to 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. Medical Release and Authorization As a parent and or/ Guardian of the named student, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of an emergency which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment or other undue pain, suffering or discomfort, if displayed. Permission is hereby granted to the attending physician to proceed with any medical or surgical treatment, x-ray examination and immunizations for the named athlete/ student. In the event of an emergency arising out of serious illness, the need for major surgery , or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to Sustainable Me and its affiliates including Directors, Coaches, Staff, and Administrators to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorization on the dates and/ on duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of. Life and limb of the named minor child, in my absence. 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. Full Name * Electronic Signature * Signature Date * MM DD YYYY Thank you for registering! Your information has been recorded. A member of our team will reach out with more information.
