BCA Summer Sports Camp
Please fill out one form per camper.
Family Information
Parent Name *
Your answer
Address *
Your answer
Email *
Your answer
Phone Number
Your answer
Campers Name: Last, First *
Your answer
Grade for 2019-20 School Year *
T-Shirt Size *
Your answer
Emergency Contact Information
Emergency Contact First and Last Name *
Your answer
Emergency Contact Phone Number *
Your answer
Emergency Contact Relation to Camper *
Your answer
Release Information
My child may be released to the following individual if I am unable to pick him/her up from camp. *
Your answer
Phone Number *
Your answer
Relation to camper *
Your answer
I certify that my child is in good health, has had a medical examination within the past twelve months, and is clear to participate in all summer sports camp activities. *
Insurance Information
Provider Name *
Your answer
Policy Number
Your answer
Group ID #
Your answer
Permission and Waiver of Liability and Authorization of Care
For good and adequate consideration, the sufficiency and receipt of which is hereby acknowledged, the Undersigned hereby authorize and grant to Bridgeway Christian Academy, its employees, directors, agents and representatives (collectively referred to herein as the “Academy”) his/her permission to allow: (i) the Camper to participate in this on-campus and/or off-campus activity which is sponsored, approved and/or sanctioned by the Academy (the trips which may be away from the Academy’s premises)(referred to herein as the “Activity”); (ii) the Academy to secure, direct and authorize reasonable and/or necessary emergency medical attention and care for the Camper, as determined in the sole discretion of the Academy, and where the Undersigned cannot be reached through reasonable efforts otherwise prior thereto; and (iii) the “Day Care Provider” or “Caregiver” (if any) listed (or such persons’ authorized representative(s)) and/or any of the persons listed as an authorized “Caregiver” to deliver and/or pick up the Camper to or from the Academy’s premises under any circumstances. Should the Camper be required to leave the event or function due to disciplinary reasons, any transportation expenses involved will be the parent’s financial responsibility and not the responsibility of the Academy, its employees, designated adult chaperones, or agents.As part of the above cited consideration, the Undersigned agree to absolve, release, indemnify and hold the Academy harmless from any and all claims, demands, suits, actions, causes of actions, and liabilities, including attorneys’ fees, resulting from personal or property injury, loss or liability, and/or asserted by the Camper, the Undersigned and/or any other party, arising from or related to the Activity (except where such claim is based upon the sole wrongful conduct or gross negligence of the Academy). The Undersigned further agree to absolve, release, indemnify and hold the Academy harmless from any and all claims, demands, suits actions, causes of actions, and liabilities, including attorneys’ fees, arising from or related to emergency medical attention or treatment provided to the Camper. The Undersigned agree that if medical attention and/or treatment is provided to the Camper, as contemplated above, the Academy will not be financially responsible for said medical attention and/or treatment of the Camper. The Undersigned agree to pay all financial obligations incurred as a result of such medical attention and/or treatment. Please select that you agree to this Permission and Waiver of Liability and Authorization of Care* *
Photo Release and Consent for Summer Camp
The Academy’s ability to portray its program accurately and vibrantly depends on the parents’ support and the Academy’s use of images of campers and their work. Therefore, the Undersigned authorize the Academy to use the Camper’s name, photographic image (including portrait, picture, video, or other reproductions), audio recordings of the Camper’s voice, video-recordings of the Camper and likeness, written or in electronic format, and/or reproductions of the Camper’s work (collectively referred to herein as the “Personal Information”) in the Academy’s publications (e.g., the Academy’s newsletter), marketing and promotional materials, website, social media, press releases, and/or advertising media. A descriptive title referring to a team, class, or grade level may be used in connection with the use of the Camper’s Personal Information. The Undersigned waive the right to inspect or approve the finished product, including written or electronic copy, wherein the Camper’s Personal Information appears. The Undersigned also acknowledge the Academy’s right to crop or alter any photographic image of the Camper at its discretion. The Undersigned authorize the Academy to use the Camper’s Personal Information, as described herein, on more than one occasion, without limitation of the number of times it is used, in perpetuity. The Undersigned authorize the Academy to reproduce, or cause to be reproduced and used, the Personal Information described herein.Please select if you agree to the Photo Release and Consent
Electronic Signature
Signature of Parent or Guardian *
Your answer
Today's Date *
MM
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DD
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YYYY
By checking the box below, I hereby accept that entering my name and today's date in the "Signature of Parent or Guardian" boxes above provides a digital signature to Bridgeway Christian Academy. *
Required
Camp Selection
Please select your BCA Sports Camp Option(s)
Once you complete this form, you will receive a confirmation email. The payment link is in that email. Registration is only guaranteed with full payment. *
Full refunds will only be given for cancellations made two weeks prior to camp start date (June 3 for volleyball and soccer, June 10 for basketball). *
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