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BGCAA Summer Camp Application form
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Great Futures Start Here
Which Club Site
*
Wiley H. Bates
Admiral Oaks
Bywater
Freetown Village
Heritage Overlook
Meade Village
Full name of child
*
Your answer
Birthday
*
MM
/
DD
/
YYYY
Child's Race
*
Black or African American
White
Latino
Multi-racial
Asian
Native American
Gender
*
Female
Male
Prefer not to say
Other:
School Lunch Program
*
Free
Reduced
Paid in Full
Parent/Guardian Name & Address
*
Your answer
Parent/Guardian Phone number & Email
*
Your answer
Household Composition
*
Both Parents
Single Mother
Single Father
Grandparents
Legal Guardian
Other
Are you a Military family
*
Yes
No
Household Income
*
$30,750 or less
$30,751-$51,250
$51,251-$72,500
$72,501 or more
Date of last Tetanus shot
*
MM
/
DD
/
YYYY
Shirt size
*
Your answer
Does your child take medication?
*
Your answer
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