REGAL Summer Camp Application

Queen Academy REGAL Summer Camp Participant Application

Thank you for your interest in the Queen Academy REGAL Summer Camp! Please complete this application in full. Incomplete applications may not be considered. This program is exclusively for middle and high school girls currently in foster care through Georgia’s Department of Family and Children’s Services (DFCS).

CAMP DETAILS:

Program Duration: June 9th - July 3rd (Three days per week), 9:00 am-3:00 pm
Eligibility: Middle and high school girls in Georgia's DFCS foster care system
Activities: STEAM education, Bible studies, financial literacy, life skills, arts & crafts, sports recreation, career exploration & entrepreneurship
Project-Based Learning: Participants will work on entrepreneurship projects and present to stakeholders at the end of camp.
Camp Tuition: $225.00 per week. Tuition includes all meals (breakfast, lunch, and snacks), as well as all field trips, and activity/project materials. Camp tuition reimbursement may be available. Please speak with your child’s case manager or Independent Living Coordinator. Camp payments are due on Monday of each camp week.

SECTION 1: PARTICIPANT INFORMATION

Full Name

Preferred Name if different

Date of Birth MMDDYYYY

Date

Age

Grade Level 20242025 school year

School Name

T-Shirt Size: (Circle one) XS / S / M / L / XL / XXL

Please fill in your child's T-Shirt size.

Allergies or Medical Conditions

Dietary Restrictions

Does the participant require any special accommodations If yes please explain

Are there any academic or behavioral concerns or diagnoses that camp staff should be aware of If yes please explain

SECTION 2: PARENT/GUARDIAN INFORMATION

Full Name

Relationship to Participant

Address

City

State

Zip Code

Email Address

example@example.com

Emergency Contact (if different from above):

Phone Number

Please enter a valid phone number.

Name

Relationship

Phone Number

Please enter a valid phone number.

Phone Number

Please enter a valid phone number.

SECTION 3: CAMPER EXPERIENCE & INTERESTS

Why are you interested in attending the Queen Academy REGAL Summer

Why are you interested in attending the Queen Academy REGAL Summer Camp

What are your favorite subjects or activities in school

What hobbies or extracurricular activities do you enjoy

What do you hope to gain from participating in this camp

Do you have any experience with STEAM activities leadership or community service If SO please describe

SECTION 4: PARENT/GUARDIAN CONSENT

(Parent/Guardian Name), give permission for my child, (Participant Name), to attend the Queen Academy REGAL Summer Camp. I understand that this camp includes various educational, recreational, and community-based activities, and I consent to my child's participation in all program events.

Ialso grant permission for my child to be photographed or recorded for

program documentation and promotional purposes.

Name

First NameLast Name

Name

First NameLast Name

ParentGuardian Signature

Date

SECTION 5: DFCS CASEWORKER INFORMATION (If applicable)

Caseworker Name

Agency Name

Phone Number

Please enter a valid phone number.

Email Address

example@example.com

Additional Notes or Special Considerations

SECTION 6: TRANSPORTATION & EMERGENCY CONTACTS

Authorized individuals for pick-up and drop-off:

Name

Relationship

Phone Number

Please enter a valid phone number.

Name

Relationship

Phone Number

Please enter a valid phone number.

Please submit completed applications via email to info@queenacademy.org. For questions, contact Danielle Pojah at dwashington@queenacademy.org or 770-742-9883. Applications are due by Friday, May 16th, 2025.