2023 Summer Day Camp Registration Form

2025 Summer Day Camp Registration Form
Due to the high volume of summer day camp registrations, not all applicants can be accepted. Each applicant will be notified of acceptance or being placed on a waiting list by April 9th. Berean Academy students will receive priority consideration for available openings.

Registration fees will be refunded to applicants who are not accepted into the day camp.
Date of Application*

MonthDayYear
Parent/Guardian Information
Guardian's Name*

First NameLast Name
Guardian's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is Guardian's relationship to the child?*
Guardian's Mobile Number

Area CodePhone Number
Guardian's Work Number

Area CodePhone Number
Guardian's Home Number

Area CodePhone Number
Guardian's E-mail
Camper Information
Child's Name*

First NameMiddle NameLast Name
Child's Gender*

MaleFemale
Child's Birth Date*

MonthDayYear
Has the child completed kindergarten?*

YesNo
School or preschool the child attended during the 2024-2025 school year*
School the child will attend for the 2025-2026 school year*
Emergency Information
Emergency Contact 1's Name*

First NameLast Name
Relationship*
Emergency Contact 1's Phone Number*

Area CodePhone Number
Emergency Contact 2's Name

First NameLast Name
Relationship
Emergency Contact 2's Phone Number

Area CodePhone Number
Emergency Contact 2's Alt. Phone Number

Area CodePhone Number
Weekly Rates: $180 per camper

$135 (May 28 - 31 only)

$6/Day for optional lunch (campers may bring a sack lunch)

Includes field trips

To receive the weekly rate, campers must be registered for the entire week. Refunds or credits will not be issued for weekly campers who miss a day of camp.

Daily Rate: $60

$6 for lunch

Additional cost for field trips
State any chronic health, emotional, or physical problem(s) the child has. Include allergies.
Please check the weeks you are registering your child to attend.*

Week 1, May 27 (4-day week)Week 2, June 2Week 3, June 9Week 4, June 16Week 5, June 23Week 6, July 7Week 7, July 14Week 8, July 21
Note: Camp will be closed the week of the 4th of July (June 30 - July 4).

The last day of summer day camp is July 25.
If registering for single days of camp, enter the dates for which you are registering.
Notice of Non-Discrimination

Berean Day Camp admits all qualified applicants regardless of race, gender, color, or national and ethnic origin.
Waiver of Liability

I/We consent to permit my child/children to participate in any and all activities conducted by the Berean Baptist Church/Berean Day Camp. I/We will hold Berean Baptist Church harmless for any injury which may occur to my/our child during summer camp activities.
Confirmation/Submission

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Signature: Use your mouse to sign.*
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Summer Camp Registration Fee$75.00

Total $0.00
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2025 Summer Day Camp Registration Form