Love Speaks Summer Camp 2026 Registration
Letting Our Voices Emerge. July 31, 2026 from 7:30 AM to 4:00 PM at 712 Oak Cir Dr W Str C, Mobile, AL 36609. Registration fee is free and includes breakfast, lunch, charcuterie class, notebook, pen, water tumbler, and drawstring bag.
Parent/Guardian Information
Parent/Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Stepparent
Grandparent
Foster Parent
Legal Guardian
Other
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Camper Information
Child Full Name
*
First Name
Middle Name
Last Name
Age
*
Date of Birth
*
-
Month
-
Day
Year
Date
Grade Entering for 2026-2027 School Year
*
Please Select
6th
7th
8th
9th
Preferred Name (if different)
Health and Safety
Allergies or Medical Conditions
Medications Currently Taken-We do not administer medications.
Dietary Restrictions
Special Needs or Accommodations Needed
Behavioral, Emotional, or Developmental Concerns Staff Should Know About
Emergency Medical Treatment Authorization
*
I authorize Love Speaks staff and medical professionals to administer emergency medical treatment to my child if necessary.
Camp Interest
Why does your child or you want to attend Love Speaks Summer Camp?
What do they hope to learn or gain from this camp?
Which activities are they most excited about?
Empowerment sessions
Mental health discussions
Fitness activities
Beauty and hygiene workshops
Charcuterie class
Financial literacy
Real talk discussions
All of the above
Other
How did you hear about the camp?
Please Select
Social media
Website
School
Friend/Family
Church/Community organization
Other
Agreements and Waivers
Photo/Video Release Permission
*
I give permission for my child to be photographed or recorded during camp activities and for images to be used in Love Speaks promotional materials.
Transportation Agreement
*
I understand that transportation to and from camp is not provided and I am responsible for my child’s transportation and will be on time to pick my child up.
Medical Emergency Authorization
*
I authorize Love Speaks staff to seek emergency medical care for my child if needed and understand that I am responsible for any related costs.
Camp Rules Agreement
*
I have reviewed the camp rules with my child and we agree to follow all guidelines.
Liability Waiver
*
I release Love Speaks, its staff, volunteers, and partners from liability for ordinary risks associated with participation in camp activities.
Authorized Pickup & Release Persons
Please list any trusted adults who may pick up your child from camp. We’ll keep this information easy to read and use only when needed.
Contact 1
Alternate Pickup Person Full Name (1)
First Name
Last Name
Relationship to Child (1)
Phone Number (1)
Please enter a valid phone number.
Format: (000) 000-0000.
Is this person authorized to pick up the child from camp? (1)
Yes, this person is authorized to pick up my child
Campers will only be released to authorized individuals listed on the form with valid identification if requested.
Optional Involvement and Sponsorship
Would you like information about volunteer opportunities with Love Speaks?
*
Yes
No
Would you like information about sponsorship opportunities for the camp?
*
Yes
No
Signature Section
By selecting Submit you consent and signature this application.
Submit Registration
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