Please complete one form PER student. This form is required for the HPCA Day Camp students (not specialty campers).
Student's Name *
Age (as of May 1, 2022) *
Rising Grade *
Mother's Name *
Mother's Cell Phone Number *
Mother's Work Number
Father's Cell Number
Father's Work Number
Registration/Activity Fee: $55.00/per student, non-refundable due at the time of registration.
7:30 a.m. - 12:30 p.m. - $135.00/per week
7:30 a.m. - 2:30 p.m. - $145.00/per week
7:30 a.m. - 4:00 p.m. - $165.00/per week
If your child is attending a specialty camp such as Lego, All-Star Sports, Baseball, etc., you will need to register and pay for that camp separately.
If your child attends one camp, you will receive a $50 discount for Summer Day Camp that particular week. If your child attends two camps in the same week, you will receive a $100 discount for Summer Day Camp that particular week.
Day Camps will provide a morning snack for all campers, and a late afternoon snack for students staying until 2:30 or 4:00 p.m. All students will be provided with a freshly-prepared hot lunch on Mondays and Wednesdays each week.
My child will attend Summer Day Camp: * (1 required)
Daily until 12:30 p.m.
Daily until 2:30 p.m.
Daily until 4:00 p.m.
Anticipated Daily Drop Off Time *
Select the weeks you are registering for Summer Day Camp
May 31 - June 3, 2022
June 6 - 10, 2022
June 13 - 17, 2022
June 20 - 24, 2022
June 27 - July 1, 2022
NO CAMP THE WEEK OF JULY 4 - 8 , 2022
July 11 - 15, 2022
July 18 - 22, 2022
July 25 - 29, 2022
Allergies/Medical/Special Needs/Parent’s Wishes
If your student has allergies or other medical or special needs, please list below. Some field trips may expose students to allergens such as nuts, animals, insects, and various plants. Please understand that some special needs may prevent a student from participating in some events. Parents should provide sunscreen for use on their child.
Allergy/Medical/Special Needs/Parent's Wishes Information
The following people (other than parents listed above) have permission to pick up my child:
All billing for the Summer Day Camps are non-refundable unless there is a health mandate on campus deemed by the administration. Your BLACKBAUD Account will be charged 25% of the total you have registered for in May. For example, if you registered for six weeks for a total of $960.00, your BLACKBAUD account will be charged $240.00 during your May BLACKBAUD draft date. Once you register, please make any changes by April 15, 2021 as to not incur these charges.
Your BLACKBAUD Account will be charged in May, June, and July for your registration during these months. If you need to make any changes to your schedule for May, June, or July after April 15, you will need to do so by the 15th of the month prior as to not incur these non-refundable charges.
A late fee is charged for children not picked up by your allocated pick up time. Failure to pick up your child will result in a charge of $1.00 for every minute a child remains in the Summer Day Camp after their allocated pick up time. Late charges will be added to your BLACKBAUD Account.
Elementary Campers may participate in various field trips (movies, parks, skating, playgrounds, etc.) via HPCA Buses. Parents will be notified prior of any field trips.
PERMISSION TO PARTICIPATE/ASSUMPTION OF RISK: I/We give permission for my/our child to participate in athletic competitions, school-sponsored trips, and campus activities throughout the school year. I/We understand that students will be accompanied by a teacher/coach and will be under adequate supervision. I/We understand that there is a risk of injury and exposure to infectious diseases with participation in these activities. In consideration of my/our child being allowed to participate in these activities, I/we assume to take responsibility for those ordinary and reasonable risks associated with participating in these activities. Sports injuries and infectious diseases can be severe and in some cases may result in permanent disability or even death. I/We agree to hold harmless High Point Christian Academy (HPCA), its affiliated organizations, employees, agents, and representatives, including volunteer and other drivers, from any and all claims arising from my/our child’s participation. This release agreement does not apply to claims of intentional (criminal) misconduct or gross negligence by the school, its employees, or volunteers. If such circumstances are proved in a court of law, I/we acknowledge and agree that the school can assume no financial liability beyond its actual liability insurance policy in force.
PERMISSION TO TREAT/RELEASE OF MEDICAL INFORMATION: I/We give consent for trained school staff to provide first aid, preventive, rehabilitative, and/or emergency treatment to my/our child if he/she becomes injured or sick while participating in a school-sponsored trip and/or athletics. I/We understand that the trained school staff will work within the confines of their specific professional certifications and licensures. In the case of a non-life-threatening medical issue, I/we request that the school contact me/us. If the school cannot reach a parent/guardian after conscientious effort, I/we give permission for school staff to call paramedics or any licensed physician or dentist if school personnel deems necessary. If a life-threatening emergency exists, I/we give permission for school staff to call paramedics immediately and then contact me/us as soon as possible thereafter. I/we authorize and consent to any x-ray examination, anesthetic, medical, dental, or surgical treatment, and/or hospital care which, in the best judgment of a licensed physician or dentist is deemed advisable. I/we agree to assume the financial responsibility for expenses incurred as a result of emergency transport and/or the previously mentioned services being provided. I/We give permission for the release of health information including verbal, print, fax, and electronic media, for the treatment of my/our child, within FERPA/HIPAA guidelines, to the appropriate HPCA personnel and/or attending health care providers.
Permission to participate is given in accordance with all materials signed upon enrollment and on file at the school office. Attendance for this outing is a privilege that may be revoked if the student is not prepared for the outing or does not comply with the school handbook or supplementary policies. Parents are expected to make travel arrangements and pay for the expenses if a student needs to be returned to school for disciplinary or health reasons.
Permission is given for HPCA and the news media to photograph and video campers and to use the materials in social media, school publications, websites, and other community media outlets.
I agree to adhere to the policies and procedures that are included in the Preschool/Elementary Handbook and this form.
New families for the 2022-2023 school year must also complete the Emergency Contact Health Form, HPCA Safe & Healthy Toolkit, and submit any required Immunization Records and other forms.
Parent Name for Consent *
Date Label *
Enter Your Email Address: *
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