4 Yrs Old | HCA Summer Camp Registration Form

Summer Camp Registration

FOR 4 YRS OLD
2025 Weekly Camp Schedule

*Off-Site Field trips are only for 1st graders & up
Student Information*

First NameLast Name
Does your child currently attend HCA?*

YesNo
Grade in the Fall 25/6
Gender*

MaleFemale
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information #1
Name*

First NameLast Name
Relationship*
Cell Number*
E-mail*
example@example.com
Parent/Guardian Information #2
Name*

First NameLast Name
Relationship*
Cell Number*
E-mail*
example@example.com
Who is preferred contact?*

Parent/Guardian #1Parent/Guardian #2Other
If you picked other, please list who should be contacted and their phone number
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*
Phone Number*
Student Health Insurance*
Policy Number*
Physician Name*

First NameLast Name
Alt. Phone Number*
Dentists Name*

First NameLast Name
Phone Number*

Approved Student Pick Up List

All persons authorized to pick up students need to be listed and will need to show identification at the time of pick up. Anyone not listed will not be able to pick up your child.
Approved Pick Up - Name*

First NameLast Name
Approved Pick Up - Phone Number*
Please enter a valid phone number.
Approved Pick Up - Name*

First NameLast Name
Approved Pick Up - Phone Number*
Please enter a valid phone number.
Approved Pick Up - Name

First NameLast Name
Approved Pick Up - Phone Number
Please enter a valid phone number.

HCA Sunscreen Authorization
HCA provides the following "bulk sunscreens" for the 2025 Summer Camp kids. The sunscreen will be used topically and applied to exposed skin to provide protection from the sun. We can't guarantee which sunscreen will be applied during your child's summer camp session. If your child needs a specific sunscreen, we suggest you send them in with a sunscreen from home.

Please visit the HCA Summer Camp website to download the appropriate sunscreen forms.
I authorize the use of the following "program provided sunscreen on my child.*

YesNo, I will provide my own sunscreen for my childI do not want sunscreen applied to my child
If you are providing your own sunscreen for your child, please list the name of the sunscreen that will be provided and the expiration date. Also, please make sure to clearly label your sunscreen bottle with your child's first and last name.

Medical, Field Trip & Communication Release
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe and include any medications needed and instructions.*
Permission for medical treatment: I, the parent or guardian hereby give permission that my child may be given emergency treatment to include first aid and CPR by a qualified staff member at CrossPointe Church and/or Heritage Christian Academy, I also give permission for my child to be transported by ambulance, treated by aid car and/or paramedics personnel, and/or transported to an emergency center/hospital for treatment. In the event that I cannot be contacted, I further authorize and consent to the medical, surgical, dental and hospital care, treatment and procedures to be performed for my child by a licensed physician or hospital when deemed immediately necessary or advisable by the physician to safeguard my child’s health. I waive my right to informed consent to such treatment.

Permission for field trips: (All preschool field trips are on-site.) I hereby give permission for my child to participate in all activities and field trips. I also give permission for my child to travel in vehicles operated by HCA. I will be notified in writing of all activities and field trips prior to the field trip or activity and obtain specific written permission for my child’s participation.

Communications: Certain information about your Student will be in the HERITAGE CHRISTIAN ACADEMY’S CAMP directory for internal and emergency use. The School/Camp does not publish a Camp wide directory. You grant the School/Camp permission to include any photograph or image of your Student in any School/Camp newsletter, web page, website, promotional marketing materials, catalogue, advertisement or other School/Camp document or publication unless you initial the statement below.

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.
Parent does NOT give the School/Camp permission to publish any photograph or image of Student in any School/Camp web page, website, document or publication."
Date*

MonthDayYear
Date
Signature*

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Summer Camp Details

Half Day: 9:00am - 12:00pm $40/day

Full Day: 9:00am-4:00pm $78/day

Camp Registration Fee & Payment
- Please check the boxes next to the camp days in each week you would like to register your student. You can choose half day or full day camp on each day, so your summer camp schedule is totally customizable.
- You will need to pay the registration and all camp fees before you can submit your completed summer camp registration.
To prepare for camp, please be sure to check out the camp details on our website HCA Summer Camp

Registration Fees: All campers need to pay a one-time, non-refundable, registration fee. HCA families need to pay a $100 registration fee per student. Non- HCA families need to pay $150 registration fee per student.

Cancellation Policy/Refunds on Summer Camp Fee: In order to recieve a refund on your summer camp fees, you need to cancel more than 14 days before the start of the week's summer camp session. If you cancel within 14 days of the summer camp starting, no refund will be given. To request a refund, please go to our summer camp website and fill out the Summer Camp refund request form.

Before & After Care: This summer, Before and After Camp care will be a prepaid flat rate. There will be no drop-in Extended Care. Advanced Registration is required for Before and After Care. The Before and After Care Registration form can be found on our website at HCA Summer Camp Information.

Registration Availability: Summer Camp & Before/After Care Registrations will close the Wednesday before that week session starts. For example, registration for week #1 (6/16-6/20) will close on Wednesday, 6/11.

We do not allow campers to switch days once they are registered.

Please keep in mind our Summer Camp program is very popular and will fill to capacity. Please plan to register for all desired weeks as soon as possible.
While we recommend you register for all sessions up front to ensure availability, if you decide to add camps after your initial registration, please contact summer@hcabothell.org to receive a code to waive another registration fee. Each camper only needs to pay the registration fee once for the entire summer.
2025 Summer Camp Field Trip Schedule

*Please note offsite field trips are only available for FULL DAY campers in 1st grade and up.
Summer Camp Selection
- To register, please select the week you are registering for under "Categories."
- Each week of Summer Camp is customizable.
- Select if you would like half day or full day camp each day of the week. You selection will add in your cart for purchase.
- When you are done, you will need to pay for all of your summer camp selections before your registration is complete.
- If a camp day is sold out, go to our website to fill out a Waitlist form for that day and if a spot opens up we will notify families in the order their waitlist requests are received.

My Products*

Registration Fee

Summer Camp Registration Fee

$150.00

Enter coupon

Total

$0.00

Payment is required in order to secure your seat in Summer Camp. Please pay via PayPal/Venmo and then submit your registration.
Payment Methods

Fastlane Checkout

Choose from one of the PayPal options to make your payment.

Contact Info

Payment Info
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Summer Camp Registration

2025 Weekly Camp Schedule

HCA Sunscreen Authorization

Medical, Field Trip & Communication Release

2025 Summer Camp Field Trip Schedule

Payment is required in order to secure your seat in Summer Camp. Please pay via PayPal/Venmo and then submit your registration.