Location (required)

The participant’s custodial parent/guardian must complete the following information.. Any changes to this form should be provided to the D.R.E.A.M.S. team upon participant’s arrival to the program.

Summer Participant:

First Name (required) :

Middle Name :

Last Name (required) :

Grade Entering (required):

D.O.B (required) :

Gender (required) :
 Male Female

Address (required) :

City/State (required) :

Zip (required) :

Parent/Guardian Name (required) :

Email (required) :

Home Phone :

Work Phone :

Cell Phone (required) :

Other Parent/Guardian Name :

Email :

Home Phone :

Day Phone :

Cell Phone :

Emergency contact if parent/guardian cannot be reached (authorized to release child to):

Name :

Home Phone :

Cell Phone :

D.R.E.A.M.S. Release Agreement 2015

Dear Parents and Guardians,

Please read through the document carefully and sign the release agreement at the bottom of the page. All rules and guidelines are put in place to ensure that all participants have a safe and fun experience. We want this to be an exciting experience that your teen will benefit from.

The following Code of Ethics will be expected of all participants:

  • Be polite, friendly, and courteous.
  • No disrespect to the D.R.E.A.M.S. team or any participant of the program.
  • No damage or vandalism to any property.
  • No bullying, fighting, or threatening of any nature.
  • No possession of drugs, alcohol, tobacco, or weapons of any kind
  • No “rough play” behavior that may be unsafe to others or self
  • Help others identify their talents to the fullest
  • Take responsibility for your own actions.

I have read and understand the above-mentioned Code of Ethics. I agree that not adhering to the Code of Ethics may result in suspension from the program.

I understand that pictures will be taken throughout the week. I hereby give permission for the pictures to be used to promote future D.R.E.A.M.S. projects. I give permission for my child’s belongings to be searched, with my child present, when the D.R.E.A.M.S. team finds it necessary to protect the well-being of my child or any other participant.

I understand that my child will participate in various activities throughout the week, some which may be strenuous. I would like for my child to participate in all activities (please see enclosed schedule) AND I release the D.R.E.A.M.S. team or any volunteer from all liability that may result from personal injury or injuries to property, resulting from any physical activity.

Parent/Guardian Name :

Write us your thoughts about this post. Be kind & Play nice.