Summer Camp Registration Form

BCA Summer Camp Registration 2023
Camper Name
Last Name*
First Name*
Middle Name*
Gender*

MaleFemale
Camper's Information
Address*
City*
State*
Zip*
Home Phone*

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Grade entering in the fall*
Does your child know how to swim?*

YesNo
Does your child need a life jacket when swimming?*

YesNo
Select the weeks your child will be attending.*

Week 1: May 30 - June 2 - Honesty & Humility - Six Flags Over TexasWeek: June 5-9 - No CampWeek 2: June 12 - 16 - Unity & Teamwork - Hawaiian FallsWeek 3: June 19-23 Perseverance, Diligence, and Patience - GoApe Ziplining @ River Legacy*Week: June 26 - 30 - No CampWeek 4: Love & Compassion - NRH20Week 5: July 10 - 14 - Kindness and Friendliness - Cheeky MonkeyWeek: July 17 - 21 - No CampWeek 6: July 24 - July 28 - Truthfulness and Integrity - Main EventWeek 7: July 10 - 14 - Loyalty & Dependability - Andretti Indoor Karting & Games
Camp Buddy

List first and second choice, not all requests are quaranteed.
Camp Buddy #1
Camp Buddy #2
Parent or Legal Guardian Information
Parent/Legal Guardian*
Relation*
Work Phone*

Area CodePhone Number
Cell Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area CodePhone Number
Cell Phone 2

Area CodePhone Number
Church Information
Church you attend
Church City
Church you are coming with (if any)
Email Confirmation
Parent's Email
example@example.com
Camper's Email
example@example.com
Other Information
How did you hear about Camp BraveHeart?
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the health officer at that time.

Please bring all medication in original container. All prescriptions must be in the camper's name and the correct dosage.
Is camper free from infectious desease or conditions?*

YesNo
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Please list any activities the camper should be restricted from.*
Please list any physical, mental or other conditions that would require special attention or medication while at camp.*
List any past medical treatment that would be helpful for us to know.*
List any allergies (ex: bees, peanuts, dairy, etc.)*
List any dietary needs that we should know about.*
List all medications, both prescribed and over the counter, all medications will be turned into the office except rescue inhalers. Please bring all medication in original containers.*
Camper Release
Please list all persons, including parents, to whom your camper can be released to.*
By selecting submit and placing your signature below, you agree that you are the parent or legal guardian of the above named camper and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel.

I understand that the above named camper will only be released to the names listed above, an update may be done at registration. I certify that my child has my permission to attend camp and participate in all activites. I authorize Braveheart Christian Academy to use my camper's picture, testimony, and video in any promotional material (web, print, or media).
Signature*

Clear
Typed signature*
Registration Fee

A registration fee of $50 is due at the time of registration. This fee covers a portion of activities and field trips throughout the duration of the summer.
Registration Payment
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Credit Card - Processing Fee$51.50

Send via Zelle - info@braveheartacademy.org $ Free

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

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BCA Summer Camp Registration 2023

Camper Name

Camper's Information

Camp Buddy

Parent or Legal Guardian Information

Church Information

Email Confirmation

Other Information

Health Information

Camper Release

Registration Fee