Specialty/Sports Camp Enrollment Form

Specialty/Sports Camp Registration

Basketball, Soccer, Volleyball, Bricks 4 Kidz, Kindergarten/First Grade Camps, Fine Arts camp, and Academic camps Please fill out one form per child
CHILD INFORMATION:
Child Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date *

Month Day Year
Grade Entering in Fall of 2021 *

Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade 9th Grade 10th Grade 11th Grade 12th Grade
PARENT/GUARDIAN INFORMATION:
Household *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Home Phone Number *

Area Code Phone Number
First Parent/Guardian
Name *

First Name Last Name
Cell Phone Number *

Area Code Phone Number
Work Phone Number *

Area Code Phone Number
Email *
example@example.com
Relationship to child: *
Employer *
Employer Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Second Parent/Guardian
Name

First Name Last Name
Relationship to child:
Cell Phone Number

Area Code Phone Number
Work Phone Number

Area Code Phone Number
Email
example@example.com
Employer
Employer Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Emergency Contacts/Authorized Pick up

Please list 2 emergency contacts with phone numbers. Please indicate if they are also an authorized person to pick up your child.
Emergency Contact #1 *
Please provide name, relationship, address, and phone number and yes/no for authorized pick up
Emergency Contact #2 *
Please provide name, relationship, address, and phone number and yes/no for authorized pick up
Additional Authorized Persons to Pick up
In addition to your emergency contacts, list the names, relationship, address, and phone number of those whom you authorize to pick up your child.
Program Selection

Please select the camp(s) you would like your child to attend: Please Note: Registration for Bricks 4 Kidz camps is directly through Bricks 4 Kidz. The link for each camp offering is below.
Please choose which camp(s) your child will attend. Registration for each session closes one week prior to the session start date.
June 1-4

Girls Volleyball Camp Grades 5-8 3pm-4:30pm $125 ($200 for both weeks or $25 drop in per day) Girls Volleyball Camp Grades 9-12 4:30pm-6pm $125 ($200 for both weeks or $25 drop in per day)
June 7-11
June 7-11

Musical Theater Camp (Grades 3-5) 10am-12pm $150 Boys Basketball Camp Grades 1-4 8am-10am $100 Boys Basketball Camp Grades 5-8 10am-12pm $100 Girls Volleyball Camp (JUNE 8-11) Grades 5-8 3pm-4:30pm $125 ($200 for both weeks or $25 drop in per day) Girls Volleyball Camp (JUNE 8-11) Grades 9-12 4:30pm-6pm $125 ($200 for both weeks or $25 drop in per day) Co-Ed Soccer Grades 6-8 (JUNE 7-9) 8am-9:30am $50 Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
June 14-18

2nd and 3rd grade Reading and Writing Camp (entering 2nd or 3rd grade) 8:30a-11:30a $85 First Grade Readiness Camp (entering First Grade/just finished Kindergarten) 1 spot left! 8a-12p $85 Co-Ed Soccer Grades 9-12 (JUNE 15-17) 8am-9:30am $50 Choir Camp:Tropical Escape Grades 1-5 9am-12pm (2 week camp June 14/15/17/18 & 21/22/24/25) $250 Broadway Bound Musical Theater Camp Grades 1-8 1pm-4pm (2 week camp June 14/15/17/18 & 21/22/24/25) $250 Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
Sibling attending K-5 Soccer Camp June 16-18?
Sibling name
Bricks 4 Kidz: Game On & Stop Motion Animation

9a-3p $210 (ages 5 and up) You must click the link to Register for this session through Bricks directly.
June 21-25

2nd and 3rd Grade Math Camp (entering 2nd or 3rd grade) 8:30am-11:30am $85 Kindergarten Readiness Camp (5 years old and entering Kindergarten in Fall 2020) 8a-12p $85 Girls Basketball Camp Grades 3-5 8am-10am $100 Girls Basketball Camp Grades 6-8 10am-12pm $100 Girls Basketball Camp Grades 9-12 1pm-3pm $100 Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
Sibling attending Grade 6-12 Soccer Camp June 23-25?
Sibling name
Bricks 4 Kidz: Sports Fanatics & Robotics

9a-3p $210 (ages 5 and up) You must click the link to Register for this session through Bricks directly.
Bricks 4 Kidz:Mining & Crafting & Robotics

9a-3p $195 (ages 5 and up) You must click the link to Register for this session through Bricks directly.
June 28- July 2

Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
Bricks 4 Kidz:Galaxy Far Away & Robotics

9a-3p $195 (ages 5 and up) You must click the link to Register for this session through Bricks directly.
July 12-16

Co-Ed Soccer Grades 3-5 (JULY 14 & 15) 8am-9:30am $50 Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
Bricks 4 Kidz: Cruisin' the Jungle & Stop Motion Animation

9a-3p $210 (Ages 5 and up) You must click the link to Register for this session through Bricks directly.
July 19-23

Extended Care K-5 7a-8:15a and 3p-6p ($6/hr)
Bricks 4 Kidz: Career Camp & Robotics

9a-3p $210 (Ages 5 and up) You must click the link to Register for this session through Bricks directly.
We are not able to refund for days your child misses due to illness. *

I understand the sick day policy
MEDICAL INFORMATION
Doctor Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Hospital Preference *
Dentist Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Permission to Treat: The staff at North Valley Christian Academy has my permission to administer basic first aid. *

Yes No
Does the student have any medical conditions? *

Yes No
Medical Conditions
Does the student have any allergies? *

Yes No
Allergies:
Does your child have a health condition that will require accommodations in the classroom? (Examples would include, but are not limited to, diabetes, seizure disorders, gastrointestinal disorders, orthopedic issues.)
I understand the risk to my child and family of contracting COVID-19 by applying for this summer camp session. *

Yes
Payment Information
If your student was enrolled in NVCA during the 20/21 school year, your payments will be made automatically through your FACTS account and the weekly camp fee is due 1 week prior to your child's attendance for each session.

If your student was not enrolled in NVCA during the 20/21 school year, payment will be made by cash or check due the week prior to your child's attendance for each session. There is an option to pay by credit card with a 2.85% service fee on each total amount charged.

Payment must be made the week prior to your child's session attendance in order for your child to attend.
I understand the payment policy. *

Yes
I give permission for my child to be photographed for editorial, promotional, and audiovisual presentation by NVCA with the understanding that his/her name will not be used. *

Yes No
Parent Handbook Acknowledgement

Please see below to view the Parent Handbook
I acknowledge that I have read the parent handbook and will adhere to it's policies. *

Yes No
Electronic Signature Page

The electronic signature below and the related field is treated by North Valley Christian Academy like a physical handwritten signature on a paper form.
Agreements

My signature below affirms that all of the information contained in this enrollment packet is correct, complete, and honestly presented. I understand that withholding or misrepresenting information in this packet may jeopardize my child's enrollment.
Check for electronic signature *

Electronic Signature
Name *

First Name Last Name
Date *

Month Day Year
Date
Registration Fee
Extended Care for Summer Camp 2020 Registration fee is $25.00 per student.

If you have signed up your child to use Extended Care before and/or after one of our Bricks 4 Kidz, Sports camps, or other specialty camps, this fee will apply.

Registration fees are non-refundable.
Extended Care Registration Fee (Grades K-5 only)

1 child
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Specialty/Sports Camp Registration

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

First Parent/Guardian

Second Parent/Guardian

Emergency Contacts/Authorized Pick up

Program Selection

MEDICAL INFORMATION

Payment Information

Parent Handbook Acknowledgement

Electronic Signature Page

Agreements

Registration Fee