East Tampa Summer Brain Booster Camp

East Tampa Summer Brain Booster Camp

"Safe Day of Learning & Play"
B.E.A.U.T.E (pronounced beauty) Blueprint Foundation Inc. will be hosting an 8-week summer camp for school aged students that live in East Tampa communities. Camp will take place Monday through Wednesday 9:00 am to 2:00 pm abd on Thursday 9:00 am to 3:30 pm. We will be serving students that reside in zip codes 33604, 33605, 33610, 33617, and 33619. If you are interested in enrolling your child, please complete the form below. 25 students will be selected. Your child must be able to attend all camp days. Once accepted an email will be sent out with more details.

Your child will be provided a safe space to play, develop their reading & math skills, social emotional development, mental health wellness and mentorship. There will be exciting opportunities for your child to explore and participate in experential field trip.

Please note if your child(ren) participated in our summer camp last year and was dismissed due to inappropriate behavior or excessive absences an interview must be completed to determine eligibility to participate in the camp.
Demographic Information
Student Full Name

First NameLast Name
Child's Shirt Size

Youth XSYouth SYouth MYouth LAdult SAdult MAdult LAdult XLAdult 2X
Gender

MaleFemale
Race

BlackBi-racialHispanicWhiteOther :
Student Number (often known as their lunch number)
What grade will your student be entering in this upcoming school year?

1st2nd3rd4th5th6th7th8th
Name of your child's school
The East Tampa Brain Booster Summer Camp will take place at Exciting Faith Alive Enrichment Center 5705 E 32nd Ave. Tampa, FL 33619. Will your child have transportation to ensure arrival and dismissal to the campsite on each day?

YesNo
Youth will be required to wear their camp field trip shirt every Thursday. Will you be able to provide $30 for your child's Tshirt and lunch bag

Yes,No, I'm not interested in this opportunity at this time
Head of Household (for data purposes only)

FemaleMale
Number of People in your Household (for data purposes only)
Free or Reduced Lunch (for data purposes only)

YesNo or Did Not ApplyUnsure
Annual Household Income(for data purposes only)

Less than $20,000$20,000 to $34,999$35,000 to $49,999$50,000 to $74,999Over $75,000
Contact Information
Parent Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email Address (Your information will not be sold)
example@example.com
Parent Cell Number
Please enter a valid phone number.
Parent Work Number
Please enter a valid phone number.
Electronic Emergency Card
Emergency Contact # 1

First NameLast Name
Emergency Contact # 1
Please enter a valid phone number.
Emergency Contact # 2

First NameLast Name
Emergency Contact # 2
Please enter a valid phone number.
Allergies, Medications, or Medical Concerns
Electronic Parent Waiver Form
This is an electronic version of our parent/guardian waiver form and to be completed only by a parent/legal guardian. Please inital below for each of the following statements to indicate your permission and complete the electronic signature before submitting your East Tampa Summer Brain Booster Camp registration.
I give permission for my child to participate in the East Tampa Summer Brain Booster Camp sponsored by the B.E.A.U.T.E Blueprint Foundation Inc. [initial below]
I give permission for my student to have contact with the personnel of B.E.A.U.T.E Blueprint Foundation Inc. and participate in designee activities, field trips, academics, and behaviors. [initial below]
I give B.E.A.U.T.E Blueprint Foundation Inc. permission to photograph my child and use their likeness in a photograph, video, or other digital media ("photo") in any and all of its publications, including web-based publications, without payment or other consideration. [initial below]
I give permission for my child to be transported by B.E.A.U.T.E Blueprint Foundation Inc. and their designee to sponsored activities and field trips. [initial below]
I give permission to my child to attend any field trip sponsored and/or facilitated by B.E.A.U.T.E Blueprint Foundation Inc. I also understand that unanticipated situations and problems can arise in any trip and I agree to release and hold harmless the program, its agents, employees, and volunteers, from any and all liability, claims, suits, demands, judgements, costs, interest and expense, (including attorney's fees and costs) arising from such activities, including any incident or injury to the child and the costs of medical services. [initial below]
I give consent to and authorize the personnel and volunteers of the B.E.A.U.T.E Blueprint Foundation Inc. and their designee to take whatever reasonable steps he/she deems necessary in order to provide emergency medical care for my child. I further agree to permit my child to be transported to medical facility by ambulance or other commercial vehicle.[initial below]
I will ensure that my child attends camp each day and arrives/depart on time.[initial below]
I understand that if my child does not complete the camp, service learning project, or misses a day, he/she will forfeit any incentives.[initial below]
By typing your full legal name below, you are signing this Parent/Guardian Waiver Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this form.
Please verify that you are human*
Should be Empty:

East Tampa Summer Brain Booster Camp

Demographic Information

Contact Information

Electronic Emergency Card

Electronic Parent Waiver Form