CCA Summer Camp 2026 Registration Form

It is our policy to contact the parent(s) or guardian(s) listed below as soon as possible in the event of a serious accident or injury. If the information entered below changes, please immediately inform the camp director.
Parent/Guardian Information

#1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
E-mail (camper confirmation will be sent to this email)*
example@example.com
Cell Phone*
Format: (000) 000-0000.
Home Phone*
Format: (000) 000-0000.
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Place of Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Format: (000) 000-0000.
Cell PhoneWork PhoneHome Phone

Parent/Guardian Information

#2
Parent/Guardian 2

First NameLast Name
Relationship to Child
E-mail
example@example.com
Cell Phone
Format: (000) 000-0000.
Home Phone
Format: (000) 000-0000.
Yes
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent's Place of Work/School Name
Or enter N/A if not applicable
Parent's Work/School Phone
Format: (000) 000-0000.
Cell PhoneWork PhoneHome Phone

Emergency Contacts/Authorized Pickup

Should the parent/guardians listed be unavailable, please provide two additional emergency contacts who are nearby and over the age of 18.
Emergency Contact/Authorized Pickup

#1
Full Name*

First NameLast Name
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Email
example@example.com
Relationship to Child*
Emergency Contact/Authorized Pickup

#2
Full Name*

First NameLast Name
Primary Phone Number*
Format: (000) 000-0000.
Secondary Phone Number
Format: (000) 000-0000.
Email
example@example.com
Relationship to Child*
List names of any additional approved pick-up persons to whom your camper can be released:

Medical / Health Information
Name of Physician or Clinic/Hospital*
Phone Number*
Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Date of Last Tetanus or Diphtheria, Tetanus, Pertussis (DTaP) Vaccine?*

MonthDayYear
YesNo
YesNo
Please list and explain any allergies (use "n/a" if not applicable)*

0/150
YesNo
Please explain (use "n/a" if not applicable)*

0/150

Medication Administration at Camp

PLEASE NOTE: All medications, in their original containers with camper's name and correct dosage clearly marked, must be turned into the camp director upon arrival. The form below must be signed by the camper's physician and submitted with the medication.
List all medications, both prescribed & over the counter (use "n/a" if not applicable).*

0/150
If applicable, upload a scanned file of the Request for Medication Administration Form once signed and completed by Physician:

Cancelof
List any additional information about your child that would be useful for staff to know, such as fears, eating or sleeping habits, or special routines. *

0/200
Yes, I give permission for my child's image to be used for the school website, social media accounts, and other promotional materials related to Cresset.No, I do not want my child's image used for promotional materials related to Cresset. Please only share pictures of my child with me.

Consent and Acknowledgement
Payment and Statement of Understanding

$300 Weekly Fee will be invoiced by Cresset Christian Academy through FACTS for current students. For non-Cresset students, checks should be made payable to Cresset Christian Academy with camper's name in memo line. Billing questions should be addressed to Brian Worley at bworley@cressetchristian.org.
- Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in any and all activities prepared by Cresset Christian Academy during the selected camp. In exchange for the acceptance of said child’s candidacy by Cresset Christian Academy, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Cresset Christian Academy and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against Cresset Christian Academy including all staff and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.
- Medical Release and Authorization As Parent and/or Guardian of the named camper, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named camper. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to CCA Summer Camp and its affiliates including directors, staff and volunteers to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release is authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
- 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.
By signing, 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 treatment for the above named camper by authorized personnel. I understand that the above named camper will only be released to the parent, guardian or authorized pickup names listed above (an update may be completed at registration). I certify that my child has my permission to attend camp and participate in all activities. *
Type first and last name above to consent
Sign Form*

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Date Signed*

MonthDayYear
Camp Director Name and Contact Info
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CCA Summer Camp Registration 2026

Camper's Information

Parent/Guardian Information

Parent/Guardian Information

Emergency Contacts/Authorized Pickup

Emergency Contact/Authorized Pickup

Emergency Contact/Authorized Pickup

Medical / Health Information

Medication Administration at Camp

Consent and Acknowledgement

Payment and Statement of Understanding