Brave New School Summer Camps 2023
Camp Registration Form 2023
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Thank you so much for registering! 

We are excited for a super fun summer! 
Name of Camper: *
Address: *
Birth date:
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Week(s) attending:
 *
Required
Name of Parent or Legal Guardian:
 *
Area Code and Telephone Number:
 *
Other numbers where I can be reached:
Email address: *

The following people are to be contacted in an emergency, or are authorized to pick up my child(ren) if I cannot be reached:       

*please list at least two, list their relationship to the child, and their phone number.


 *
Is anyone not authorized to pick up your child? If yes, please contact us to inform the administration of the situation.
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My child has my permission to participate in Brave New School Camp activities. I am familiar with and approve of the mode of transportation, leadership accompanying the group.  I certify that the above named camper is in good health and is able to participate in all normal activities of the group:    
*
If No, what are the limits to their participation? Specify:
The minor is currently under a doctor's supervision for:
Current medication(s):
Is minor allergic to any medication:
*
Any medications needed to be administered during camp:
Date of last tetanus shot:
*
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Family Medical Insurance Coverage:
*
Medical Insurance Policy Number:
 *
Family Physician and phone number:
 *
Whenever it may be deemed necessary, I authorize the calling of a doctor and/or providing of other necessary medical services and, unless covered by insurance, agree to pay for the same. I understand that reasonable measures will be taken to safeguard the health and safety of the young people and that I will be notified as soon as possible in case of an emergency. However, should you accept the applicant as a participant, I agree to indemnify and hold harmless group leaders, or any other representative of the church, or the church itself, or Brave New School and its Camps responsible in the event of sickness or accident involving my son or daughter no matter how caused. 
*
I would also like to enroll my child for before and after care. *
Thank you so much for registering! 

The cost for each week is $125.

The cost for before and after care (8am-4pm) is $50 per week.

We are excited for a super fun summer! 

Someone will be in contact with you soon to set up payment arrangements and secure your child's spot. 

If you have any questions, please contact Brien @ (757)-822-8675.
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