2025 Summer Camp Application

A completed application must be submitted for each camper separately.

"*" indicates required fields

1Student Info

2Mother Info

3Father Info

4Authorizations

5Emergency Contacts

6Consent

Student Information

Student Name*

First Middle Last

Student Home Address*

Street Address City State ZIP Code

Student T-Shirt Size*

Student Gender*

Male

Female

Student Date of Birth*

Student Grade*

What grade will this student attend in the new school year?

Currently Enrolled at SJBA*

Yes

Student Home Phone*

Primary Email*

Used for official school communication only

Student Medical Information

Doctor Name*

First Last

Doctor Phone*

Outstanding Medical History

Allergies

Student Medications

Date of Last Tetanus Shot*

Insurance Company*

Policy #*

Mother/Female Guardian

Mother/ Female Guardian Name*

First Last

Marital Status*

Maiden Name*

Proof of Custody*

If divorced appropriate custody paperwork MUST be uploaded.

Max. file size: 50 MB.

Home Address*

Same as student

Street Address City State ZIP Code

Personal Email*

Home Phone*

Cell Phone*

Occupation*

Employer

Work Phone*

Work Email*

Work Address*

Street Address Address Line 2 City State ZIP Code

Father/Male Guardian

Father/Male Guardian Name*

First Last

Marital Status*

Proof of Custody*

If divorced appropriate custody paperwork MUST be provided.

Max. file size: 50 MB.

Home Address*

Same as student

Street Address City State ZIP Code

Personal Email*

Home Phone*

Cell Phone*

Occupation*

Employer

Work Phone*

Work Email*

Work Address*

Street Address Address Line 2 City State ZIP Code