Summer Camp Registration FormPlease enable JavaScript in your browser to complete this form.How many kids are you registering *1123Parent Info Parent 1 Name *Parent 1 Phone *Please provide a phone number when you can be reached any time.Parent 1 Email *Relationship *MotherFatherGuardianParent 2 NameParent 2 PhonePlease provide a phone number when you can be reached any time.Parent 2 EmailRelationshipMotherFatherGuardianChildren InfoProvide the grade that your child will be attending in Fall.Child 1 InfoName Child 1 *Grade Child 1 *1-45-8Phone Child 1Email Child 1Does Child 1 have any allergies/ special dietary needs? *NoYesPlease describe in detail the allergies/dietary needs of Child 1 *Does Child 1 need any medication to be administered? *NoYesPlease let us know if your child needs any medication during the day prescription/non-prescription or emergency medication like for an allergic reaction, asthma etc.Please give detailed instructions on the medications *Child 2 InfoName Child 2 *Grade Child 2 *1-45-8Phone Child 2Email Child 2Does Child 2 have any allergies/ special dietary needs? *NoYesPlease describe in detail the allergies/dietary needs of Child 2 *Does Child 2 need any medication to be administered? *NoYesPlease let us know if your child needs any medication during the day prescription/non-prescription or emergency medication like for an allergic reaction, asthma etc.Please give detailed instructions on the medications *Child 3 InfoName Child 3 *Grade Child 3 *1-45-8Phone Child 3Email Child 3Does Child 3 have any allergies/ special dietary needs? *NoYesPlease describe in detail the allergies/dietary needs of Child 3 *Does Child 3 need any medication to be administered? *NoYesPlease let us know if your child needs any medication during the day prescription/non-prescription or emergency medication like for an allergic reaction, asthma etc.Please give detailed instructions on the medications *Emergency Contact Info Please provide us with two emergency contacts, not living in the same household. We will verify the ID of the contact if arriving at the camp site in person. Please update us with any changes to this information during the camp. Emergency Contact 1 Name *Emergency Contact 1 Phone *Emergency Contact 1 Email *Relationship with the Emergency Contact 1 *Emergency Contact 2 NameEmergency Contact 2 PhoneEmergency Contact 2 EmailRelationship with the Emergency Contact 2Please read the Terms and Conditions for attending the camp. Registration Fees: The registration fee per child is $275 if registered on or before December 31st. The registration fee per child will increase to $300 starting January 1st. Sibling Discount: A 10% discount is available for each additional sibling registered after the first child. This discount is applicable to the base registration fee of each sibling. The sibling discount will be applied only when multiple children from the same family are registered at the same time. Cancellation and Refund Policy Partial Refunds: If a cancellation request is submitted on or before January 31st, 50% of the registration fee will be refunded. For cancellations submitted after January 31st and before April 1st, 25% of the registration fee will be refunded. No Refunds After April 1st: Cancellations made on or after April 1st will not be eligible for any refund. Terms & Conditions: You must complete and submit the registration form on behalf of your child(ren) and pay the full camp fee by the specified deadline. Each student / counselor is required to wear the CM Gurukul issued QR badge for the entire duration of the camp, including check in and check out and responsible for preserving the same. You will provide us with accurate and complete information about your child(ren)’s health, allergies, dietary needs and emergency contacts. You understand participation in any summer camp activity may involve physical activity exposing your child(ren) to certain risks and dangers. Accidents and injuries are always a possibility, and it is impossible to foresee and protect your child(ren) from all conceivable dangers because of their participation in the summer camp. You will ensure that your child follows the camp rules and respects the staff, facilities, and other campers. Any violation of these may result in dismissal from the camp of your child(ren) without refund. CMA reserves the right to dismiss any student who violates the camp rules or causes harm to others or themselves. In consideration of child(ren)’s participation at the summer camp, and without any further consideration from CMA, You hereby grant permission to CMA, staff, volunteers, and affiliates to utilize my child(ren)’s appearance, performance or voice in any and all manner and media throughout the world for the purpose of promotion, reporting or publication. CMA may use my child(ren)’s, likeness, voice and biographical material in connection with publication, promotion, exhibition and distribution of such material. You understand that no royalty, fee or any other compensation of any kind shall become payable to you by reason of such release and use of any photograph. You must provide us with accurate and complete information about your child’s health, allergies, dietary restrictions, medications, emergency contacts and any special needs. You must also inform us of any changes to this information during the camp session. You understand that in an event of illness, injury, and/or accident, You authorize the camp instructor or any CMA volunteer, camp staff, teacher or CMA Board member or Officer to act on your behalf. They may approve any and all non-emergency or emergency treatment and are authorized to sign any and all medical release or required form(s) on your behalf. In the event of an emergency, I understand that I will be notified of the situation as soon as practicable. I agree to pay any necessary expenses incurred in the medical treatment of my child, including, but not limited to all transportation costs to and from a medical facility, and, if necessary, transportation to my home or medical facility of choice. You will assume full responsibility for any damage or loss caused by your child(ren) to the camp property or equipment. You must ensure that your child(ren) arrives and departs from the camp site on time and with the appropriate clothing, equipment, and supplies. CMA is not responsible for any lost or damaged items. You must follow our rules and policies regarding safety, discipline, hygiene, communication and participation. We reserve the right to dismiss any camper who violates these rules or disrupts the camp environment without refund or compensation. You must sign a waiver of liability and indemnity agreement that releases us from any claims or damages arising from your child’s participation in the camp activities. You also agree to cover any costs or expenses incurred by us in case of an emergency involving your child. We require inspection of government issued identification for each guardian for the safety of your child. I have read and agree to the Terms and Conditions mentioned above. *AgreeWaiver and Release of Liability I WAIVE, RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for disability, personal injury, property damage, property theft, or actions of any kind which may hereafter occur to my children from participation in this camp and its activities, THE FOLLOWING ENTITIES OR PERSONS: Chinmaya Mission Alpharetta Inc., and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers; INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation in this camp, whether caused by the negligence of release or otherwise. I acknowledge that Chinmaya Mission Alpharetta and their directors, officers, volunteers, representatives, and agents are NOT responsible for errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf. I hereby consent to medical treatment to my child (ren) which may be deemed advisable in the event of injury, accident, and/or illness during this camp. I have read the above Waiver and Release. I agree to the clauses set forth above. *AgreeBy signing below, I agree to all Terms and Conditions, and Waiver and Release of Liability. Please sign. * Clear Signature How would you like to pay for the Camp fee? *Credit CardTotal Order Summary Item Quantity Total There are no products selected. How many kids are you registering – 11$275.00How many kids are you registering – 21$522.50How many kids are you registering – 31$770.00Total$275.00 $0.00Stripe Credit Card *CardName on CardSubmit