City of Antioch Fall Teen Camp 2026

Bridge Builders Exploration Camp – Registration

A day camp in partnership with the City of Antioch, held in the spring, summer and fall. Campers tour colleges, visit museums, learn about the trades, make art and more.
Which camp session are you registering for?
Camper Information
Camper full legal name

First NameLast Name
Preferred name
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
Current grade
School currently attending
Gender / pronouns
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Camper cell phone
Please enter a valid phone number.Format: (000) 000-0000.
Camper email
example@example.com
Parent/Guardian Information
Parent/Guardian Full Name

First NameMiddle NameLast Name
Relationship to Camper
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Second Parent/Guardian Name

First NameMiddle NameLast Name
Second Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Second Parent/Guardian Email
example@example.com
Emergency Contacts & Pickup
Emergency Contact 1 Full Name

First NameLast Name
Emergency Contact 1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 1 Relationship
Emergency Contact 2 Full Name

First NameLast Name
Emergency Contact 2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact 2 Relationship
Adults Authorized to Pick Up Camper
Individuals Not Authorized to Pick Up Camper, Including Any Custody Order Information
May your teen sign themselves out and leave camp independently at 3:00 PM?
Health & Medical
Does the camper have any allergies?
If yes, please describe the allergies and any reactions
Does the camper carry an EpiPen or inhaler?
Medical conditions we should know about
Medications taken during camp hours
Dietary restrictions for lunch

Other
Physician name

First NameMiddle NameLast Name
Physician phone number
Please enter a valid phone number.Format: (000) 000-0000.
Health insurance provider
Accommodations or support needs (IEP/504, behavioral, accessibility, or other needs)
Camper Interests
Career fields you are interested in exploring
Business idea or interest in entrepreneurship
What do you hope to get out of this camp?
Permissions & Waivers
Required acknowledgements
Permission for pool/water activities (when offered during the session)
Photo and media release
Camper signature
Parent/guardian signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Liability waiver notice
Field trip consent
Medical treatment authorization notice
Should be Empty:

Bridge Builders Exploration Camp – Registration

Camper Information

Parent/Guardian Information

Emergency Contacts & Pickup

Health & Medical

Camper Interests

Permissions & Waivers