Student InformationCamper's Legal Name:* First Middle Last Suffix Date of Birth:* Date Format: MM slash DD slash YYYY Gender:*MaleFemaleCurrent Age:*5678910What Grade is Your Child Entering in 2020-2021?*HealthAny Previous Illness or Physical Limitations? (Please Give Detailed Descriptions):Does the Camper Have Any Allergies?*YesNoPlease Describe Your Son's or Daughter's Personality*Please Describe Your Family*What Motivates Your Child?*How Did You Hear About Grace Academy's Summer Camp?*EnrollmentCheck all that apply.Session I June 22-26 Under the Sea Ocean Explorers June 29-July 3 - Mad Science July 13-17- Animal Planet Session II July 20- 24 Splish Splash Water Week July 27-31- Building/Legos (STEM) Will Your Child Be Need Before / After Camp Care?Before CareAfter CareParent / Guardian InformationFather or Male Legal Guardian First Last Home Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Work Phone:*Cell Phone:*Email* Enter Email Confirm Email Mother or Female Legal Guardian First Last Home Address Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Work Phone:*Cell Phone:*Email* Enter Email Confirm Email Emergency Contact InformationIf parent is unreachablePrimary Emergency Contact* First Last Relationship to Student:*Cell Phone:*Secondary Emergency Contact* First Last Relationship to Student:*Cell Phone:*Permissions and ConsentFor your convenience in meeting your financial obligations, camp fees are due by the Friday prior to your chosen camp dates. Registration fees are due at the time of application submission. Yes, I understand and acknowledge my camper may participate in a variety of activities including: swimming, outdoor games, sports and other activities. I will not hold Grace Academy or their staff accountable for accidental injuries. Yes, I give permission for my child to be used in public relations materials, promotional materials, social media or on the Grace Academy website. Yes, I give permission for my child to access the internet, computers and iPads with supervision during camp hours. Yes, I understand that camp hours are from 8:30 a.m. – 3:30 p.m. I understand that extended care is available before or after camp hours for an additional fee. I understand that typing my full legal name in the box below constitutes a legal signature confirming that I have read and agree to the above consent form.Digital Signature:*Date* Date Format: MM slash DD slash YYYY
