CYDI Summer 2023 | June 17th - August 1st
INNOVATE. EXPLORE. CREATE.

The CYDI SUMMER CAMP will be a fun and exciting experience for Musicians, Artists, Creatives, and Entrepreneurs. Youths aged 12 and up will work/play in hands-on labs to develop skills, knowledge, and leadership abilities and even meet new friends.

Take the first step today and secure your spot in our FREE Camp. $20 Non-Refundable enrollment fee per child.
June 17th - August 1st | 9am-3pm Monday-Thursday
Sign up below. Registration closes 06.01.24

CAMP REGISTRATION

Fill out the registration form below and one of our representatives will be in touch.

Student Name

First Name

Last Name

Student Date of Birth

YYYY

Student Email

Student Phone #

(###)

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Student Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian Name

First Name

Last Name

Parent/Guardian Email

Parent/Guardian Phone #

(###)

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####

Alternate Contact

Person to notify in emergency (when parent/guardian cannot be reached)

First Name

Last Name

Alternate Contact Phone

(###)

###

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Medical Conditions or Allergies

List any medical condition or allergies

Doctor Contact

Doctor to notify in emergency

Doctor Phone #

(###)

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Medical Insurance Company

Policy Holder Name

Policy Number

MEDICAL TREATMENT AUTHORIZATION AND LIABILITY WAIVER:

I hereby give my consent to have a trainer, coach, team manager, emergency medical technician, nurse, medical treatment facility, and/or doctor of medicine or dentistry or associated personnel provide the participant with medical assistance and/or treatment and agree to be financially responsible for injury based on information provided herein. I hereby authorize emergency transportation of the applicant to a medical treatment facility should an individual listed above consider it to be warranted. I recognize the possibility of physical injury associated with basketball, and hereby release, discharge, and otherwise indemnify Community Youth Development Institute (CYDI), their sponsors and employees and associated personnel of these organizations, against any claim by or on behalf of the basketball player named above as a result of the player's participation in the CYDI basketball program and/or being transported to or from the same, which transportation I hereby authorize.

Date

Today's Date

YYYY

CYDI RELEASE:

I, the parent/guardian of the above named child consent for participation in the CYDI Sports Camp. I hereby agree that CYDI, its members, coaches, staff or officers shall not be held liable for any injury or loss which my child may sustain while participating in activities sponsored by or under the supervision of CYDI, and I agree to indemnify and hold harmless CYDI, its members, coaches, officers and sponsors, their employees and associated personnel, including the owners of the facility utilized for the programs, against any claim whatsoever.

Date

Today's Date

YYYY

CAMP LOCATION

7836 S Union Ave, Chicago, IL 60620