2024 Camp Registration Form

Today's Date

Promotional Code (Special codes for discounts or timed promotions and events)

General Information

Primary Account Name (First & Last) Person Responsible for Account

Address (Street, City, State, Zip)

Primary Phone (Include Area Code)

Email

Parent(s) Information

Mother's Name (First & Last)

Mother's Cell (Include Area Code)

Mother's Email

Mother's Work Phone (Incl. Area Code)

Father's Name (First & Last)

Father's Cell Phone (Incl. Area Code)

Father's Email

Fathers Work Phone (Incl. Area Code)

Parent's Marital Status

Alternate Mailing Address (ONLY for divorced or separated families)

If Separated Home, Camper(s) Reside Where? (Mother, Father, Other, Etc.)

Child MAY Also Be Picked Up By: (List ALL that apply, if not on the list, child CAN NOT be picked up by them.)

Child CAN NOT Be Picked Up By: (Under no circumstances will we release a child to anyone on this list.)

Emergency Information

Contact Name

Contact Phone

Relationship to Camper

Camper(s) Information

Name of Camper 1

Gender

Age

Birthday (Month, Day, Year)

Is Camper 1 A Current Student Enrolled At Inspiration Academy? (YES or NO) If Yes, List Class(es)?

Name of Camper 2

Gender

Age

Birthday (Month, Day, Year)

Is Camper 2 A Current Student Enrolled At Inspiration Academy? (YES or NO) If Yes, List Class(es)?

Name of Camper 3

Gender

Age

Birthday (Month, Day, Year)

Is Camper 3 A Current Student Enrolled At Inspiration Academy? (YES or NO) If Yes, List Class(es)?

Sessions To Attend

Spring Break Camp - Check To Attend

One Week Only - April 1 - 5

Summer Camp Sessions - Check All You Plan To Attend:

Miscellaneous

How Did You Hear About Us?

Referred By?

Misc. Information or Comments:

Agreement/Terms

Check options

I have read and understand all of the terms and conditions of the Camp Programs at Inspiration Academy. I agree to abide by all such terms and conditions including but not limited to payments, refunds, attendance, withdrawal and cancellations. I have read all payment information and understand said policy. I understand that I MUST pay a NON-REFUNDABLE deposit for each camper, for each registered week with a commitment to attend those weeks. I understand that I am responsible for the payment of the weeks I register my camper(s) for. I understand what I am responsible for and that my child will NOT be allowed to start camp weeks/sessions if there is an outstanding balance due for that session. If my child is dropped off without payment made, I will be called to pick up my child from the Camp, immediately. If collection/legal fees should apply in relation to my account, I understand I will be responsible for them.

I understand that anyone found to be violating any of the rules and regulations, code of conduct, or found to be disruptive to any individual or group may be asked to leave the premises or off-site location at any time and be refused reentrance without a refund. We ARE absolutely a bully-free camp and have zero tolerance for such activities. We want every camper, regardless of gender, race, age, etc., to have a fun, enjoyable, and memorable (with good memories) experience.

The student(s)/participant(s)/Camper(s) named above voluntarily participates in any and all Inspiration Academy activities and the student(s)/participant(s)/Camper(s) and I understand that certain risks are inherent to and from participation and involvement with Inspiration Academy and in its various formal and informal activities. These activities include but are not limited to Dance, Acro, Active Games, running, jumping, etc. I hereby release Inspiration Academy, it's emplyees. and vollunteers from any and all liability or cause of action. All due diligence is taken continuously to assure the safety of all campers in all activities. Also, Inspiration Academy is not responsible for any lost or stolen property, at any time. To protect all student's, campers, instructors, employees, volunteers, visitors, etc., video camera's are installed and visible throughout the main area's of the academy and recording all activities 24/7.

I grant permission to Inspiration Academy, its agents, and its employees the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family while attending Inspiration Academys' summer camp for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium. I hereby release Inspiration Academy and its legal representatives from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements/quotes of my child, myself, or my family members given/said during camp with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.

I hereby acknowledge that I am the parent, grandparent, or legal guardian of the registered camper(s) above and take full responsibility for all commitments within the registration agreement and I will be responsible for payment of all fees.

Payment Information

Please make note: Upon receipt of your registration, Inspiration Academy will send you an email confirming your registered information including the number of campers, the weeks you registered for, the cost of camp with any promotions if applicable, the amount paid, deposits, balance due, and more. We will also include the payment plan you opted for, and how much your evenly distributed installment payments will be, leading up to the start of camp. All Camp fees must be paid in full by your start date of camp and/or in compliance with your payment schedule. Please select your payment choice below: "pay in full", pay monthly installments (1st or 15th)" or pay bi-monthly installments (1st & 15th). You must pay your registration fee, $35.00/1 Camper, $45/2 Campers, $50/3 or More Campers. Plus Deposits: $50.00 Per Week x Camper(s) x Registered Weeks of Camp.

Check The Payment Option You Choose (Include the 1st and/or 15th Options)

SPRING BREAK - PAY IN FULL PAY ALL CAMP FEES IN FULL PAY EQUAL MONTHLY INSTALLMENTS ON THE 1ST OF EACH MONTH PAY EQUAL MONTHLY INSTALLMENTS ON THE 15TH OF EACH MONTH PAY EQUAL BI-MONTHLY INSTALLMENTS ON THE 1ST AND THE 15TH OF EACH MONTH 2022 RETURNING CAMPER/ORIGINAL WEEKLY PAYMENT STRUCTURE

I authorize Inspiration Academy to charge my credit card immediately for the Registration Fee and Required Deposits. I further authorize Inspiration Academy to charge my credit card for the recurring Installment Payments for the Balance Due on my account. I understand and agree that my credit card will be kept safely on file and charged the amount of equal installment charges in accordance with my selection above. Due to holidays, weekends, and/or administrative processing, I am aware that my card will be processed on, or reasonably thereafter, the date I have selected, but never early. A receipt for each payment will be provided to you, and the charge will appear on your Credit Card statement.

I (the Cardholder) understand that this authorization will remain in effect until my total balance of Summer Camp fees are paid in full. I agree to notify Inspiration Academy in writing of any changes to my account information prior to the next billing date. I understand that if Inspiration Academy receives a decline while attempting to charge my card on the agreed-upon date(s), a $45.00 fee will be charged to my account. I certify that I am an authorized user of this Credit Card and will not dispute these scheduled transactions; so long as the transactions correspond to the terms indicated in this registration form.

Credit Card Information

Card Type

Cardholder Name (As shown on card)

Card Number

Card Expiration

CVC Code

Zip Code (from credit card billing address)