2026 Youngstown Summer Experience Camp Sign Up

2026 Youngstown Experience Summer Camp invites local youth to learn, explore, and grow together 🎒. Campers will enjoy hands-on activities, daily meals, and safe spaces for reading, STEM projects, and creative play.

Hosted by Promise-CommunityHub, this camp reflects our commitment to educational support, food security, and community connection. Your registration helps us provide supplies, technology access, and caring mentors so every child can fully take part 🌟

Dates: June 8-August 14, 2026
Monday-Thursday 8:30 am to 3:00pm
Location: 336 Breaden St.
Youngstown, OH 44502
One Time $20 Registration Fee is required to compete application

Child

First Name*

Last Name*

Gender

Male
Female

Grade*

Birthdate*

Age*

Street Address*

City*

State*

Zip*

Child Lives With:*

Parent/Guardian - Contact Information

Parent/Guardian

Parent/Guardian First Name*

Parent/Guardian Last Name*

Contact E-mail*

Contact Phone Number*

Street Address*

City*

State*

Zip*

Work Phone Number*

Occupation

Emergency Contact Information

Emergency Contact #1

First Name*

Last Name*

Contact E-mail*

Contact Phone Number*

Relation to Child*

Work Phone Number*

Are they permitted to pick up child?

Yes
No

Emergency Contact #2

First Name

Last Name

Contact E-mail

Contact Phone Number

Relation to Child

Work Phone Number

Are they permitted to pick up child?

Yes
No

Alternate Pickup/Release

Please list those people in addition to parents/guardians who are permitted to pick up your child:

Medical Concerns/Allergies

Medical Concern

Required Treatment

Should a paramedic be called?

Yes
No

Medical Concern

Required Treatment

Should a paramedic be called?

Yes
No

Medical Concern

Required Treatment

Should a paramedic be called?

Yes
No

Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason? If Yes, please explain:*

Is your child allergic to any type of food or medication? If Yes, please explain:*

Registration Form and Release of Liability

Zero Tolerance Policy

There is zero tolerance for fighting, bullying, disrespect, and any actions that may cause harm to another person or the facility. Your child will be removed from the program if ANY of these actions occur.

Zero Tolerance Policy Agreement (Please Initial)*

Photo Release

I hereby give permission for my child to be photographed during the Youngstown Summer Experience Camp. I un-derstand the photos will be used to keep a journal of activities, to share during power point presentations and/or re-ports and for promotional purposes including flyers, brochures, newspapers and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of Southside Summer Experience Camp and its affiliates.

Do you agree with this photo release?

Yes
No

Youngstown Summer Experience Camp, and its co-organizers are not responsible for lost or damaged personal property

All scheduled events are subject to change. Children’s photos and quotes may be used for publicity purposes

In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician)

Parent/Guardian Initials*

Participation Consent Form

I, the undersigned*, herby release discharge, indemnify, hold harmless and defend Youngstown Summer Experience Camp, its officers, employees and servants from any and all liability (claims, demands, losses, causes of action, suits, judgements) of any kind that I or my family may have against District due to death, personal injury or illness, loss or damage to property, or future causes that occur during the 2026 Youngstown Summer Experience Camp. In the event of any medical emergency, I authorize and consent for Youngstown Summer Experience Camp to act on my behalf for medical care deemed necessary for the participant.

Type Name to Agree*

Date