2026 EXPLORE Summer Camp Enrollment Permission Form

2026 EXPLORE Summer Camp Permission and Waiver Form page 1

Typed signature acknowledgment Child’s Name first and last Child’s Date of Birth Gender or pronouns Address City State ZIP

School district for 2026 to 2027 school year

Amanda-Clearcreek Berne Union Bloom-Carroll Canal Winchester

School district for 2026 to 2027 school year line 2

Fairfield Union Lancaster Liberty Union Pickerington Walnut Township

School grade for 2026 to 2027 school year

6th Grade 7th Grade 8th Grade

Pickup person one name Pickup person one relation Pickup person one phone number Pickup person two name Pickup person two relation Pickup person two phone number Healthcare Heroes initial Builders Camp session 1 initial Builders Camp session 2 initial Team STEAM Camp session 1 initial Team STEAM Camp session 2 initial

2026 EXPLORE Summer Camp Permission and Waiver Form page 2

Known allergies or medical conditions Known dietary restrictions Parent or guardian name Parent or guardian telephone numbers Parent or guardian email Secondary emergency contact name Secondary emergency contact telephone numbers Secondary emergency contact email Name of child’s primary care physician Contact number of child’s primary care physician

Emergency transport permission

Yes No

Anything else staff should know

2026 EXPLORE Summer Camp Permission and Waiver Form page 3

Printed name for waiver section Relationship to child for waiver section Email address for waiver section Telephone number for waiver section Date for waiver section Printed name for photo release section Relationship to child for photo release section Signature for photo release section Date for photo release section

2026 EXPLORE Summer Camp Reasonable Accommodation Request Form

Child’s name first and last Summer camps registered for Weeks attending Requested accommodations or modifications Additional information

2026 EXPLORE Summer Camp information page

Email Jenni Sturgeon Call Jenni Sturgeon