Braselton Christian Academy Summer Camp Registration Form

Last Name*

First Name*

Gender*

MaleFemale

Grade

Age

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

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

Parents Email (camper confirmation will be sent by email, if left blank it will be mailed)

Camper's Email

I give permission for my child to participate in all camp activities, including scheduled on-site and off-site field trips. I understand that my child may be transported by school or camp staff using approved transportation methods and will be supervised at all times. I acknowledge that participation in camp activities and field trips involves inherent risks, and I voluntarily assume full responsibility for any such risks. I hereby release, waive, and hold harmless the camp, school, its owners, directors, employees, volunteers, and affiliates from any and all liability, claims, demands, or causes of action arising out of or related to my child’s participation. In the event of an emergency and I cannot be reached, I authorize the camp or school staff to obtain necessary medical treatment for my child. I acknowledge and accept all camp policies and procedures related to participation, transportation, and safety.

Is camper free from infectious desease or conditions?*

YesNo

Are immunications up to date?*

YesNo

All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.

Any activity the camper should be restricted from?*

Any physical, mental or other condition 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)*

Any dietary needs that we should know about?*

List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.*

If paying by check, please submit the registration fee as soon as possible. Checks should be made payable to ICRO Kingdom Ministries. Payment may also be submitted via Zelle to 404-509-1990. Multiple camper registration fees may be paid with one check; please include the camper’s name(s) in the memo line. Any remaining balance is due at any time prior to the camper’s scheduled week of camp.

Camper Release (List anyone, including parents, to whom your camper can be released)*

Be certain to enter your email address correctly on the registration form to receive confirmation via email with in 2 weeks

By hitting submit and putting your initials, 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. The camp carries secondary insurance. 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 Braselton Christian Academy to use my camper's picture, testimony, and video in any promotional material(web,print,or media) My child may recieve any e-mails from the camp.

Signature*

Electronic signature, please initial*

Summer Camp Registration

Camper Name

Camper's Information

Parent or Legal Guardian Information

Email Confirmation

Field Trip Permission

Camper Release