Summer Camp Registration

Summer Camp Sessions

SESSION 2 IS COMPLETELY BOOKED

What session would work best for you?

Child's Information

What's your child's full name?

When is your child's birthday?

What's your child's ethnicity?

What grade will your child enter in Fall 2025?

Please describe your child’s interests and personality in a few words.

Does your child have a 504 or IEP Educational Plan?

Does your child participate in the NSLP?

Choose your child's T-shirt size

List any allergies or medical condition (N/A if none)

Parents' Information

Primary parent

Full Name

Phone number

Email

Relationship

Home Address

Authorized to pick up?

Emergency contact?

Add another person

Full Name

Phone number

Relationship

Authorized to pick up?

Emergency contact?

Remove

Add

Parental waiver and release for minor child

Please review and sign the media consent form. This grants Alianza permission to include your child in promotional materials across various media platforms, in accordance with Florida law. Your signature confirms understanding and agreement to the terms outlined.

Download Form

I give permission for my minor child (named above) to participate in the above-named activity and sign this Release and Waiver in consideration of Alianza Center granting my child permission to participate in the above-named activity at St. John’s Episcopal Church, both individually and on behalf of my child, expressly and unconditionally assume all risks and dangers, known or unknown, foreseen or unforeseen, relating or incidental to my child’s participation in the abovenamed activity.

I hereby release, forever discharge, hold harmless, and indemnify Alianza Center, its members individually, and its parents, subsidiaries, affiliates, officers, shareholders, agents, and employees of any and from all claims, demands, liabilities, costs, damages, rights and causes of action of whatever kind or nature, arising from and by reason of any and all known and unknown, foreseen and unforeseen bodily and personal injuries, death, damage to property, and the consequences thereof, resulting from my participation in or in any way connected with or incidental to the above-named activity.

I certify and warrant that my minor child is in good health and physical condition and is able to participate in the above activity.

I agree that my minor child will adhere to all applicable rules and regulations of the organization named above

I have carefully read the foregoing Waiver of Liability and Release, including the statutory notice on the first page, and know the contents thereof. I am signing this Waiver of Liability and Release as my own free act.

Parent/guardian Name

Signature Date

Witness Signature Date

Photo release waiver

Please read and sign the Parental Waiver and Release for your child before proceeding. Your signature is required for participation.

Download Form

As the parent/legal guardian, I consent to Alianza using my child’s photographs, videos, audio, or likenesses in their promotional materials, both for current and future use.

By checking this box, I confirm that the name I typed above may be used as a substitute for my signature.

Parent/guardian Name

Signature Date

2025 Summer Camp handbook

Download Handbook

By checking this box I acknowledge receiving and reading Alianza Center's "Summer, Cameras, Action" handbook and agree with all policies and procedures.

Payment information

Card holder's name

Billing email

Credit Card

Payment success

Payment failed

Payment pending

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