Summer explosion 2025

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“SUMMER EXPLOSION” THE “JOY” LIFE CENTER

STUDENT ENROLLMENT FORM

Name
Address
School Currently Attending
Grade
Date of Birth
Age
How do you get home
(Select one)





************************************************* EMERGENCY CONTACT INFORMATION *************************************************
Parent/Guardian
Phone number
Emergency Contact
Emergency Contact Phone number
Your Doctors Name
Your Doctors Number
Describe any food allergies and physical restrictions or special requirements:
Describe any food allergies and physical restrictions or special requirements:
******* PARENT RELEASE FORM **********

I release Lovejoy Community Services, Inc. from all liability arising out of any injury or illness incurred while my child is participating in this activity.
below you can choose one of two options:

I give permission or, I do not give permission for my child to be photographed to promote Summer Explosion Academic Camp. I understand that the images may be used in print publications, presentations, websites, and social media.


Electronic Signature.
Type out your first and last name and date:
Email
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