Camp BCA 2024 Registration
Please complete this form in its entirety. Registration is NOT complete until the $103 deposit has been paid.
Deposits should be made using the link below.
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Nathan Whitaker  *
Please select the weeks your child will attend. A minimum of 2 weeks is required.  Only choose the weeks your child will be present.  If your child does not attend and the spot can't be filled, you will assume financial responsibility for that week.
Please list anyone who may pick up your child, including parents
Emergency Contact 1
Emergency Contact 1 Phone number
Emergency Contact 2
Emergency contact 2 Phone number
Emergency Contact 3 *
Emergency Contact 3 Phone number *
Father/Guardian 2
Father/Guardian 2 Phone number
Father/Guardian 2 Email Address
Address
City
State
Mother's Name/Guardian 1
Mother's/Guardian 1 Email address
Mother's/Guardian 1 Phone Number
Child's Age
Child's DOB
MM
/
DD
/
YYYY
Please list any allergies
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