Emergency Release form and Activities Permissions

Emergency Form
All boxes must be checked to authorize consent.
By my signature below, I do hereby state that I am the Parent or Legal Guardian of the child named on this form. Further, I do hereby consent and agree to all stipulations initialed above.
Besides those previously designated on this form, the following person is authorized to sign my child out of the program.
Besides those previously designated on this form, the following person is authorized to sign my child out of the program.
Tuition: Fee for the 2018 Hero Spark Summer Camps is $175 per child. Please provide payment after submitting this form to confirm a space for your child. Cash or checks are accepted. Please make checks out to Hero Spark Orlando and provide an email Please email checks or money to: P.O Box 533363 Orlando, FL 32853. We will email you to confirm the receipt of your payment. Refunds: Hero Spark will refund tuition if written notice is given within 1 week of camp. Financial Aid: Partial scholarships are available. If you are interested in financial aid and can provide personal income information, please contact phil@herospark.org.