Summer Camp Registration HCS Summer Camp Flyer (International) HCS Summer Camp Flyer Preschool Summer Camp FlyerStep 1 of 911%Which summer camp are you registering for?(Required) Preschool - Students Ages 2 to Entering Kindergarten HCS Camp - Students Entering 1st Grade to Entering 7th Grade International HCS Camp - Students Ages 2 to Entering 7th GradeHiddenInternational Student Yes Yes NoHiddenInternational Student No Yes NoRegistrant InformationStudent's Name(Required) First Middle Last Suffix Date of Birth(Required) MM slash DD slash YYYY Entering Grade Level(Required)PreschoolTransitional KindergartenKindergarten1st Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th GradeWhat grade will the child enter in the Fall?AgeSex(Required) Male FemaleCamp T-Shirt Size(Required) S M L XLIncluded in your registration fee!Primary Email(Required) Primary Phone(Required)Address(Required) Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Guardian 1 InformationNot Applicable Check here if Mother / Guardian not applicable (e.g. single parent)Name(Required) First Middle Last Suffix Parent 1 Email(Required) Parent 1 Phone(Required)Parent/Guardian 2 InformationNot Applicable Check here if Father / Guardian not applicable (e.g. single parent)Name(Required) First Middle Last Suffix Parent 1 Email(Required) Parent 1 Phone(Required)Authorized ContactsPlease fill out at least 1 emergency contact.Emergency Contacts Name RelationshipActions EditDelete There are no Entries. Add Entry Maximum number of entries reached. Emergency Contact Confirmation(Required) I confirm that I have filled out at LEAST one emergency contact above.Medical InformationDoes child have any allergies?(Required) Yes NoPlease list allergies and describe treatment regimen:(Required)My child may be given Tylenol/Acetaminophen:(Required) Yes NoMy child may be given Advil/Ibuprofen:(Required) Yes NoMy child may be given Allergy/antihistamine:(Required) Yes NoDo you wish the school to give your child prescription medications?(Required) Yes NoIf you desire the school to give your child prescription medication, please come into the School Office for a Request to Dispense Medication form.Field Trip Consent & WaiverConsent(Required) As parent and/or legal guardian, I consent to the above-name student participating in all field-trips related to the summer campI consent to the afore-mentioned student participating in all an any field trips as part of the Heritage Christian School summer camp program(s).Waiver(Required) As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named student.Special Safety Issues: Parent is responsible for sun screening (we will reapply) & water bottle (at least 16 oz.). Special Items Needed: Wear camp shirt on all excursions (preschool excluded), comfortable covered shoes, no open toe (unless specified). I agree on behalf of myself, the student named herein, or our heirs, successors and assigns, to hold harmless and defend Heritage Christian School and its directors, officers, teachers, aides, staff, agents, and representatives associated with the event, from any and all actions, claims, demands, damages, costs, expenses and all consequential damage arising from or in connection with the student attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate Heritage Christian Academy, its officers, directors and agents, or representatives associated with the event for reasonable attorney’s fees and expenses arising therewith.Release and Authorization to Use Student Image As parent and/or legal guardian, I agree to the following authorization to use my student's imageRelease and Authorization to Use Student Image-Heritage Christian School may produce, participate in, or cause to be produced video, motion picture, audio recording, Web page, digital imaging, or photograph productions, broadcasts, school social media posts, and/or publications which may involve the use of students’ images, names, likenesses, and/or voices. Such productions will be used for noncommercial education, exhibition, promotional, advertising, instructional, publicity, or other purposes by Heritage Christian School and will not be sold to other school systems or education professionals. Such productions may be copied, copyrighted, edited, and distributed by the school in the manner described above. I understand that my image (if over age 18) or my child’s image, name, likeness, or voice may be used, photographed, taped, or recorded in the manner described above. I hereby grant Heritage Christian School, and anyone authorized by the school the right to use, reuse, and reproduce the video, motion picture, audio recording, Web page, digital imaging, or photograph productions, broadcasts, and/or publications as described above, without any compensation to me and/or my child. I agree that all such videos, motion pictures, audio recordings, Web pages, digital images, or photographs shall be the property, solely and completely of Heritage Christian School. Heritage may copyright such work(s)/product(s) in its own name. I hereby waive any right to inspect or approve the finished work(s)/product(s) or the uses to which they may be applied. I hereby forever release and discharge Heritage Christian School from any and all claims, actions, and demands arising out of or in connection with the use of said video, motion picture, audio recording, Web page, digital image, or photograph, including, without limitation, any and all claims for invasion of privacy and libel. This release shall also apply to the assigns, licensees, and legal representatives of Heritage Christian School, the party/parties for whom Heritage Christian School took the video, motion picture, audio recording, Web page, digital image or photograph, and the party/parties for whom Heritage Christian School took the video, motion picture, audio recording, Web page, digital image, or photograph. I have read the foregoing and fully and completely understand the contents hereof. I understand that I many rescind my authorization for use of my image or my child's/student's image at any time in writing.Parent eSignature(Required)Date Month Day YearDay/Week SelectionsHow will you make your selections for summer camp?(Required) I want to register for multiple weeks at a time I want to register for multiple individual daysDay Selections Select A Day Time OptionsActions EditDelete There are no Day Selections. Add Day Selection Maximum number of day selections reached. Day Selections Select A DayActions EditDelete There are no Day Selections. Add Day Selection Maximum number of day selections reached. Day Selections Select A DayActions EditDelete There are no Day Selections. Add Day Selection Maximum number of day selections reached. Weekly Selections(Required) June 19-23 (Week 1) June 26-30 (Week 2) July 3-7 (Week 3) July 10-14 (Week 4) July 17-21 (Week 5) July 24-28 (Week 6) July 31-Aug 4 (Week 7) Aug 7-11 (Week 8) Aug 14-18 (Week 9) Aug 21-25 (Week 10)Select All*No Childcare Available on Field Trip DaysWeekly Selections(Required) June 19-23 (Week 1) June 26-30 (Week 2) July 3-7 (Week 3) July 10-14 (Week 4) July 17-21 (Week 5) July 24-28 (Week 6) July 31-Aug 4 (Week 7) Aug 7-11 (Week 8) Aug 14-18 (Week 9) Aug 21-25 (Week 10)Select All*No Childcare Available on Field Trip DaysHiddenWeek Selections June 19-23 (Week 1) June 26-30 (Week 2) July 3-7 (Week 3) July 10-14 (Week 4) July 17-21 (Week 5) July 24-28 (Week 6) July 31-Aug 4 (Week 7) Aug 7-11 (Week 8) Aug 14-18 (Week 9) Aug 21-25 (Week 10)Select All*No Childcare Available on Field Trip DaysHiddenWeek Selections June 19-23 (Week 1) June 26-30 (Week 2) July 3-7 (Week 3) July 10-14 (Week 4) July 17-21 (Week 5) July 24-28 (Week 6) July 31-Aug 4 (Week 7) Aug 7-11 (Week 8) Aug 14-18 (Week 9) Aug 21-25 (Week 10)Select All*No Childcare Available on Field Trip DaysPaymentTo add a lunch for any of the days you've registered for, please place a lunch order through our lunch system HERE.Summer Camp Total Price: $0.00 Field Trip: June 30th Adventure City Price: Field Trip: July 14th South Coast Farms Strawberry Picking Price: Select your student's height(Required) Under 48 Inches Over 48 Inches N/A We are not registering for the week containing July 28thField Trip: July 28th Wild Rivers - Over 48 Inches Price: Field Trip: July 28th Wild Rivers - Under 48 Inches Price: Field Trip: August 11th Aquarium of the Pacific Price: Field Trip: August 25th Defy Price: Preschool Registration Fee Price: HCS Camp Registration Fee Price: International Registration Fee Price: Subtotal $0.00 Coupon/Credit Code How would you like to make your payment?(Required) Credit Card/Debit Card ACH/Bank DraftBilling Name(Required) First Last Name of the person making the paymentBilling Address(Required) Same as address Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Credit Card(Required)American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Security Code Cardholder Name Credit Card Transaction Fee Price: $0.00 Bank Details(Required) Account Number SelectSavingsChecking Account Type Routing Number Bank Name ACH Transaction Fee Price: Total Δ