Summer Camp Registration Form

Summer Camp Registration
Camper Information
Camper's Name*

First NameLast Name
Birth Date*

MonthDayYear
Camper Info*
Grade Completed (enter 0 if student completed Kindergarten)*
School*
Gender*

MaleFemale
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Parent 1 Name*

First NameLast Name
Parent 1 Home Number*

Area CodePhone Number
Parent 1 Cell Number*

Area CodePhone Number
Parent 1 Work Number*

Area CodePhone Number
Parent 1 E-mail*
example@example.com
Parent 2 Name

First NameLast Name
Parent 2 Home Number

Area CodePhone Number
Parent 2 Work Number

Area CodePhone Number
Parent 2 Cell Number

Area CodePhone Number
Parent 2 E-mail
The following persons have permission to pick up your child from Gorman Christian Academy. (Please include name, relationship, and phone number.)*
Emergency Information
Emergency Contact's Name*

First NameLast Name
Relationship*
Phone Number*

Area CodePhone Number
Does the camper have any allergies, chronic illness, or medical conditions? If yes, please describe.*
Physician's Name*

First NameLast Name
Physician's Phone Number*

Area CodePhone Number
Health Insurance Company*
Policy Number*
Camp Dates

Please select each date that your child will be attending camp.
Scheduling/cancellation policy – In order to ensure that we have a safe number of students for our campus and field trip locations, we will need accurate head counts at least two weeks in advance. Please select each date that your child will be attending camp. If your schedule changes, we will need to be notified at least two weeks in advance of that date, or you will incur a $25 late cancellation fee. Thank you for helping us keep our campers safe and healthy!
Week 1 - Amazing Amazon Animals

Tuesday June 1Wednesday June 2Thursday June 3Friday June 4All of the above
Week 2- River Rapids

Monday June 7Tuesday June 8Wednesday June 9Thursday June 10Friday June 11All of the above
Week 3 - Nations of the Basin

Monday June 14Tuesday June 15Wednesday June 16Thursday June 17Friday June 18All of the above
Week 4 - Survival Mode

Monday June 21Tuesday June 22Wednesday June 23Thursday June 24Friday June 25All of the above
Week 5 - Wild Kindness

Monday June 28Tuesday June 29Wednesday June 30Thursday July 1All of the above
Week 6 - S.T.E.A.M. on the River

Tuesday July 6Wednesday July 7Thursday July 8Friday July 9All of the above
Week 7 - Project Conservation

Monday July 12Tuesday July 13Wednesday July 14Thursday July 15Friday July 16All of the above
Week 8 - Movie Adventures

Monday July 19Tuesday July 20Wednesday July 21Thursday July 22Friday July 23All of the above
$75 registration fee due to reserve spot. Please select your payment method.*

My student is currently enrolled at GCA, and GCA has my permission to charge my FACTS incidental account within one week of receiving this application.My student is not currently enrolled at GCA, so I will mail or drop off my $75 check/cash at the school within one week of submitting this application.
Informed Consent and Acknowledgement

We are financially responsible for the weeks we reserve and will pay on Monday of each week or the first day attended. If our child needs medical services, staff members of Gorman Christian Academy have our consent to take our child to a properly licensed practicing physician or to call EMS. We release Gorman Christian Academy and its staff from any and all liability in such situations.
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.
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Summer Camp Registration

Camp Dates