2026 All-Around Achievers Summer Camp Registration Form

This summer, embark on a journey of discovery and growth with our five-week All-Around Achievers Camp! Tailored for rising 1st - 8th graders, this program offers a holistic approach to skill enhancement and personal development.

Dates: June 29 - July 31, 2026

Hours of Operation: 8 AM - 5 PM

Registration Fee: $35

Locations:

Gethsemane Baptist Church (Grades 1-8)

5405 Roanoke Ave, Newport News, VA 23605

Antioch Baptist Church (Grades 1-8)

163 Old Buckroe Road, Hampton, VA 23664

New Beech Grove Baptist Church (Grades 1-8)

361 Beechmont Drive, Newport New, VA 23608

Providence Baptist Church (Grades 1-5)

1331 30th Street, Newport News, VA 23607

First Baptist Church Denbigh (Grades 1-8)

3628 Campbell Road, Newport News, VA, 23602

Please Select a Camp Site:

Student Name

First NameLast Name

Birth Date

MonthDayYear

Rising Grade Level

Gender

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Parent Name

First NameLast Name

Parent Cell Phone

Format: (000) 000-0000.

Parent Work Phone

Format: (000) 000-0000.

Parent E-mail

example@example.com

Home Address (If different than student)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Information

Please list two people to contact if parents CANNOT be reached. (Must be local)

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Child's Physician

First NameLast Name

Physician's Phone

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

Insurance Company

Insurance Policy Number

Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the student prescribed an inhaler? If yes, please explain any instructions.

Student Pickup List

Please Note: Appropriate paperwork such as custody papers shall be attached if a parent is NOT allowed to pick up child.

Person(s) Authorized to Pick Up Child:

Authorized Pick Up Name 1

First NameLast Name

Authorized Pick up Name 2

First NameLast Name

Authorized Pick up Name 3

First NameLast Name

Authorized Pick up Name 4

First NameLast Name

Authorized Pick up Name 5

First NameLast Name

Person(s) NOT Authorized to Pick Up Child:

Not Authorized to Pick up Name 1

First NameLast Name

Not Authorized to Pick up Name 2

First NameLast Name

Not Authorized to Pick up Name 3

First NameLast Name

Not Authorized to Pick up Name 4

First NameLast Name

Not Authorized to Pick up Name 5

First NameLast Name

Policies, Procedures & Permissions

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the Greater Peninsula C.A.R.E.S. Foundation, Inc. during the selected camp. In exchange for the acceptance of said child’s candidacy by the Greater Peninsula C.A.R.E.S. Foundation, Inc., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Greater Peninsula C.A.R.E.S. Foundation, Inc. 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 the Greater Peninsula C.A.R.E.S. Foundation, Inc. including all coaches 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, including basketball. 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 athlete, 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 athlete. 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 the the Greater Peninsula C.A.R.E.S. Foundation, Inc. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release 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.

Financial Agreement

Understanding that the Greater Peninsula C.A.R.E.S. Foundation, Inc. - All-Around Achievers Summer Camp must meet its financial obligations on time, we agree to following policies: Registrations fees are per student, non-refundable and due upon enrollment.

In the event of picking up a child, after closing hours, a $5.00 late fee will be charged for every 5 minutes past closing hours until the child is picked up. (For example, if your student is picked up at 5:07pm, you would be charged $10.00).
Additional fees may be required for selected field trips.

Activity and Field Trip Permission

I, the above-named parent, being the parent or legal guardian of the youth named above, do hereby consent to the participation of my youth in all the scheduled field trips of the Greater Peninsula C.A.R.E.S. Foundation, Inc. - All-Around Achievers Summer Camp, and any other supervised activities customarily associated with its summer camp. Further, I certify that my youth is physically fit and adequately prepared to participate in all recreational and sporting events. If I wish to revoke this consent for any reason, I will promptly notify the youth leader in writing. I give my consent by typing my name below.

The Greater Peninsula C.A.R.E.S. Foundation, Inc. - All-Around Achievers Summer Camp will provide advance notice of all off site field trips.

Confirmation

BY SIGNING BELOW, I AM AGREEING TO THE ABOVE POLICEIS AND PROCEDURES OF THE GREATER PENINSULA C.A.R.E.S FOUNDATION, INC. - ALL-AROUND ACHIEVERS CAMP. FURTHERMORE, I CERFITY THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ACKNOWLEDGE THAT 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.

Date

Signature

Registration Fee Payment

Please click the link below to submit your registration fee. After completing your payment, return to this page to finish and submit your form.

Note: Your registration will not be considered complete until the registration fee has been received.

https://greaterpeninsula.securepayments.cardpointe.com/pay?paymentType=cc

2026 Summer Camp Information & Registration

Student Information