BCA Summer Registration Form

Bexar County Academy Scholar Registration Form

"Hands On Summer" Accelerated Learning Program
Personal Information
Scholar's Name

First NameLast Name
Scholar's Birth Date

MonthDayYear
Scholar's Grade
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Email
example@example.com
Food Allergies (Check all food allergies, if not listed place on the other line):

MilkEggsPeanutSoyWheatTree NutsShellfishSesameOther
Medications

AsthmaAllergyDiabetesEpinephrine Auto-injectorOther
Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Bexar County Academy during the 2021 Summer Program. Furthermore, I intend to support his/her success by ensuring he/she attends the summer program everyday to get the most out of the Accelerated Learning Summper Program and prepare him/her for the next grade level.
Confirmation 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.
Should be Empty:

Bexar County Academy Scholar Registration Form