EYP Summer Program Registration Form

EYP Summer Program Registration

June 1st - July 17th | AGES 5 - 12 YEARS OLD
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
School Name*
If you are not sure type N/A
Grade (the grade they just completed)*
MaleFemale
Additional Camper(s)

Optional
Camper Name #2

First NameLast Name
Birth Date

MonthDayYear
Grade (the grade they just completed)
MaleFemale
Camper Name #3

First NameLast Name
Birth Date

MonthDayYear
Grade(the grade they just completed)
MaleFemale
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional campers must show proof of living in the same household for a discount to be applied

Campers attending all 6 weeks of camp will be enrolled in our Full Program Option, which is $75 per camper, per week. Please note that this rate applies regardless of attendance, and payment is required for all 6 weeks.

If your camper will not be attending all 6 weeks, you may choose the Flexible Attendance Option, which is $100 per camper, per week attended. Families selecting this option will only pay for the weeks their camper is present. A $20 discount will be applied for each additional sibling enrolled under this option.

Please select your preferred payment option below for the 2026 summer. Once selected, you may only change your option one time during the summer.

Payments for the week will be due every Monday.
Will be attending all 6 weeks (FULL PROGRAM - $75 per week/ per camper)Will be choosing weeks (FLEXIBLE ATTENDANCE - $100 per camper - additional camper discount)
NoYesSome weeks I will need extended day care

Parent/Guardian Information
Parent Guardian Name #1*

First NameLast Name
Cell Number*
Format: (000) 000-0000.
E-mail*
Weekly Camper Invoice will be sent to this email
Parent Guardian Name #2

First NameLast Name
Cell Number
Format: (000) 000-0000.
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Format: (000) 000-0000.
Name of additional Individual authorize to pick up your camper(s) besides you?
Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Please list any additional adults authorized to pick up your camper(s) | Please list their LEGAL first and last name

Does your camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Type N/A if they do not have any.
Does your camper have any special needs? If yes, please list all below.*
Type N/A if they do not have any.
Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Empowering Young People during the selected camp. In exchange for the acceptance of said child’s candidacy by Empowering Young People. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Empowering Young People and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Empowering Young People including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Empowering Young People and its affiliates including volunteers, Hope International Church, and/or Hope Preparatory Academy Staff to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
By checking this box I acknowledge that I will pay camper fees according to schedule and whether your camper(s) attends one day or the whole week, the camper price is the same. No refunds
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date*

MonthDayYear
Date
Signature*

My Products

Registration Fee

A non-refundable registration fee is required to secure a camper's spot. Regardless of attendance, this fee ensures that we can accurately plan for the number of campers and secure the appropriate staffing to provide a high-quality camp experience.

$20.00 Quantity

Total

$0.00

Payment Methods

Credit Card

Apple Pay

ACH Bank Transfer

Should be Empty:

EYP Summer Program Registration

Camper Information

Additional Camper(s)

Payment Methods