Summer Camp Detailed Registration Form

Child's Name

First NameLast Name

Grade (Fall 2026)

T-Shirt Size

Week 1: May 18-22

Week 2: May 26-29

Week 3: June 1-5

Week 4: June 8-12 - Adventure Week

Week 5: June 15 - 19

Week 6: June 22-26 - Adventure Week

Week 4: June 16-20

Week 5: June 23-27

STREAM Camp(s) Attending

Minimum Due

Total Due

Pay the minimum due or total due today?

There is a nonrefundable registration fee of $25 for each camp

PayToday

Is your child allowed to have a snack or freeze pop during camps?

GCA can use pictures taken of my child during camp.

Parent/Guardian Information

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

E-mail

example@example.com

Phone Number

Format: (000) 000-0000.

Phone Value

Emergency Contact

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency phone cannot be the same as the parent phone number.

Emergency Phone Value

Alternate Emergency Contact

First NameLast Name

Alternate Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

In the event of an emergency, if I cannot be contacted, I hereby authorize that emergency treatment may be administered. I give my consent to have a licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.

Does the child have any allergies, chronic illness, or medical conditions?

Please describe the condition.

Is the child prescribed an inhaler or medications?

Please explain any instructions for the inhaler.

Parent/Guardian Consent and Medical Release I hereby request permission and give consent for my child to take part in Granville Christian Academy’s Summer Camps (The “Programs”).

In consideration of the opportunity for my child to participate in the Programs, and fully recognizing that such an undertaking involves the element of risk; I hereby release, discharge, and otherwise indemnify Granville Christian Academy, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of the fields and facilities utilized for the Programs, against any claims by or on behalf of my player son/daughter as a result of my son’s/daughter’s participation in the Programs.

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.

Signature

Total Amount Due

USDDescription

minWk1

minWk2

minWk3

minWk4

minWk5

minWk6

Payment Methods

Debit or Credit Card

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

Summer Camps Registration

Parent/Guardian Information

Total Amount Due*

Payment Methods

Total Amount Due