Northeast Summer Camp's

Registration

Please select your camp's

Camper Information

Full Legal Name *

Preferred Name (if applicable)

Date of Birth *

Age at Time of Camp *

Shirt Size

Would like add an additional camper?

Full Legal Name *

Preferred Name (if applicable)

Date of Birth *

Age at Time of Camp *

Camper Shirt Size

Full Legal Name

Preferred Name (if applicable)

Date if Birth

Age at Time of Camp

Camper Shirt Size

Parent/Guardian Information

Parent/Guardian Full Name *

Relationship to The Camper *

Primary Phone Number *

Secondary Phone Number

Email Address *

Home Address *

Preferred Method of Communication

Emergency Contact

Emergency Contact Full Name *

Relationship to Camper *

Emergency Contact Phone Number *

Accessibility & Accommodations *

Does your child require learning, physical, behavioral, or accessibility accommodations on or around the campus to ensure a positive and safe camp experience?

If yes, please describe the accommodations needed (including classroom, mobility, communication, or campus access considerations).
If no, please type N/A.

I understand that providing this information allows Houston City College to better plan and support my child’s participation, including accessibility needs within classrooms, facilities, and common areas on campus. I acknowledge that accommodations are subject to available resources, staffing, and campus infrastructure.

Accessibility & Accommodations *

Consent and Privacy Agreements

Consent and Privacy Agreements *

I, the undersigned parent or legal guardian, hereby give permission for my child to participate in the Houston City College Summer Camp Program. I understand that participation is voluntary and subject to compliance with all camp rules, policies, and procedures.

Medical Emergency Authorization

I authorize Houston City College and its representatives to seek and obtain emergency medical treatment for my child if I cannot be reached in the event of illness, injury, or other medical emergency during camp activities. I understand that every reasonable effort will be made to contact me prior to medical treatment when possible.

I acknowledge that I am responsible for any medical expenses incurred that are not covered by insurance.

Documentation Acknowledgment

I acknowledge that I have completed and submitted all required summer camp and Minors on Campus documentation accurately and in full. I understand that incomplete, missing, or inaccurate forms may delay or prevent my child’s participation in the summer camp program.

Behavior Expectations

I understand that summer camp participants are expected to:

Follow all camp rules, safety guidelines, and staff instructions
Treat other participants, staff, and property with respect
Maintain appropriate conduct at all times

I acknowledge that failure to follow behavior expectations may result in disciplinary action, up to and including removal from the program. I understand that removal due to behavioral issues may occur without refund.

Privacy and Information Use

I understand that my child’s information will be used solely for administrative, safety, and programmatic purposes in accordance with college policies and applicable privacy regulations. Information will only be shared with authorized personnel as necessary to support my child’s participation.

Acknowledgment and Consent

By signing below, I confirm that:

I have read and understand this consent and privacy agreement
I authorize my child’s participation in the summer camp
I consent to emergency medical treatment if necessary
I acknowledge behavior expectations and participation requirements

Acknowledgment and Consent Signature *