Participant Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender *

Male

Female

Other

T Shirt Size *

Field trip t-shirt

Youth Small

Youth Medium

Youth Large

Youth X-Large

Adult Small

Adult Medium

Adult Large

Adult X-Large

Primary Parent Name *

First Name

Last Name

Primary Parent Phone Number *

(###)

###

####

Secondary Parent Name

First Name

Last Name

Secondary Parent Phone Number

(###)

###

####

Camp Location Requested *

Adrenaline Sports Center, Ramsey

Centennial High School, Circle Pines

Champions Hall, Eden Prairie

Hopkins Pavilion, Hopkins

Hopkins Pavilion, SEALs (8 week program)

National Sports Center, Rink 8, Blaine

National Sports Center, SEALs (8 week program)

National Sports Center, EXPO, Blaine

Weeks Requested *

To see weekly camp schedules, visit www.akasport.org/all-sports-camp or https://akasport.org/aka-seals-intro. Please note, all AKA Summer Camp locations will run June 10-August 30. Both AKA SEALs locations will run June 10-August 15.

Week 1: 6/10-6/14

Week 2: 6/17-6/21

Week 3: 6/24-6/28

Week 4: 7/1-7/5

Week 5: 7/8-7/12

Week 6: 7/15-7/19

Week 7: 7/22-7/26

Week 8: 7/29-8/2

Week 9: 8/5-8/9

Week 10: 8/12-8/16

Week 11: 8/19-8/23

Week 12: 8/26-8/30

WAIVER OF LIABILITY/AUTHORIZATION *

In consideration of participating in AKASPORT activities and by applying for this scholarship, on behalf of myself and my children, heirs, assigns, personal representative and estate, I hereby agree to release and discharge all members of the Active Kids Association of Sport (“AKASPORT”) staff, its agents, officers, volunteers, and any other party involved in the organization and administration of the AKASPORT programs, from any claims, liabilities, causes of action, losses, costs or expenses, including all claims for personal injury, wrongful death, and property damage, caused by, or arising out of, the participation in the AKASPORT programs. I hereby declare that the enrolled applicant is in good health and in the case of emergency, I grant permission for my child to be given medical treatment at a local hospital. By filling out this form and registering online, I accept all responsibility and assume all costs that may be incurred in the event of an injury or accident. My child has my permission to be transported by AKASPORT as needed for field trips. I also understand that photographs and videos will be taken throughout the program and I hereby authorize that they may be published publicly without any further consent from me. AKASPORT reserves the right to revoke any and all scholarships if participant is unable to conduct themselves in a manner that is in the best interests of the camp program, its campers and staff.

Accept