The HUB @ Office Logic

Future Innovators Summer Camp 2026

Camper • Medical • Emergency • Pick-Up • Consent & Media Release

🧒 Camper Information

Camper Full Name *Date of Birth *AgeGrade Entering (Fall 2026)

👪 Parent / Guardian Information

Parent/Guardian Name *Relationship to CamperPhone Number *Email Address *

Home Address

CityStateZip

🩺 Medical Information

No allergies

No medical conditions

No medications during camp

Special Accommodations (physical, educational, dietary, behavioral, learning)

Physician NamePhysician PhoneInsurance CompanyPolicy Number

📞 Emergency Contacts

Emergency Contact #1

Name *RelationshipPhone *

Emergency Contact #2

NameRelationshipPhone

🚗 Authorized Pick-Up Persons

#1 NameRelationshipPhone

#2 NameRelationshipPhone

#3 NameRelationshipPhone

Government-issued photo ID may be required before a child is released.

✍️ Parent Consent & Liability Release

I give permission for my child to participate in The HUB @ Office Logic Future Innovators Summer Camp and all related activities (AI & Vibe Coding, Robotics & Engineering, Aerospace/Drone Tech, Podcasting & Digital Media, STEM workshops, guest speakers, and educational field trips). I understand participation involves inherent risks, voluntarily assume those risks, and release The HUB @ Office Logic, its owners, employees, volunteers, instructors, sponsors, and partners from liability arising from my child's participation, except as required by law. In an emergency, I authorize camp staff to secure medical treatment if I cannot be reached.

I have read and agree to the Parent Consent & Liability Release.

Parent/Guardian Signature (type full name) *Date *

📸 Photo & Media Release

Photographs, videos, and recordings may be taken during camp for educational, promotional, social media, website, newsletter, grant reporting, and PR purposes.

YES — I grant permission to use my child's photograph, video, voice, artwork, projects, and likeness for educational and promotional purposes.NO — I do not grant permission.

Parent/Guardian Signature (type full name) *Date *

Certification

I certify the information provided on this form is accurate and complete to the best of my knowledge.

Printed Name *Signature (type full name) *Date *