BeaTPAC 2019 Registration
Camper's Last Name *
Your answer
Camper's First Name *
Your answer
Camper's Age as of 6/17/2019 *
Your answer
Grade for Next School Year (2019-2020) *
Birthday (MM/DD/YYYY) *
Your answer
Identified Gender *
Your answer
Name of Parent/Guardian *
Your answer
Home Phone
Your answer
Cell Phone *
Your answer
Address *
Your answer
Email *
Your answer
Name of Emergency Contact *
Your answer
Relationship of Emergency Contact *
Your answer
Phone Number of Emergency Contact *
Your answer
Medical Conditions
Your answer
Dietary Needs (Vegetarian, Food Allergies)
Your answer
T-shirt Size *
I give the BeaTPAC staff permission to administer first aid and medication if needed. *
I have read and understand the refund policy. In order to make sure BeaTPAC can accommodate the most campers possible, I accept that they do not give refunds. *
I have enrolled my child in BeaTPAC at Creekside High School understanding that every precaution has been taken to ensure camper safety. In the case of an unlikely injury or illness, I grant permission for my child to be taken to a doctor or hospital and to be treated if the BeaTPAC staff cannot locate me or another parent/guardian. *
I also give the BeaTPAC Staff permission to use any pictures, video, or recording of my child taken as part of any camp activity for local publication and/or camp publicity and promotion. *
I understand that my spot is not reserved until my payment is received. *
I have carefully read this agreement and fully understand its contents. I am aware that this is a release of liability and a contract between me and the St. Johns County School District, Creekside High School, and the BeaTPAC Summber Camp Administration, Counselors, and Staff. By typing my name below, I sign this agreement and do so of my own free will. *
Your answer
Is there anything else you would like to tell us?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.