Student's First Namerequired

Student's Last Namerequired

Parent's First Namerequired

Parent's Last Namerequired

Parent Permission*

My student has my permission to take part in Hawaii Baptist Academy's 7th Grade Camp (Activity) at the Puu Kahea Conference Center, August 20-22, 2025. I certify that I fully understand the nature of the Activity and that I am not aware of any medical, physical or other limitations that will prevent my child from participating in this Activity, or that I have provided information about my child’s limitations.

Yes No

Parent Contact Info*

During this activity, I may be reached at: (check all that apply)

Home Work Cellular

Home Phone

###-###-####

Work Phone

###-###-####

Cellular Phone

###-###-####

For water activities, I grant permission for my child to swim.*

Yes No

Will your child be arriving late or leaving camp early?*

Yes No

Time Away from Camp

If your son or daughter must come to camp late, leave early, or leave then return to camp, this form must be completed and returned to the Christian Ministries Department no later than one week prior to the scheduled camp (exceptions may be given for funerals, etc.)

For most Hawaii Baptist Academy events (e.g. basketball game) transportation from the event to camp (or from the camp to the event) will be provided by the Christian Ministries Department in cooperation with the department involved.

Students are not allowed to drive to camp. No one is allowed to leave the camp grounds for any reason without the approval of the camp director. If the student will be arriving or departing by automobile or other private transportation, a parent/guardian must be present. Other students are not allowed to ride with other students unless the parent(s) of the driver AND the parent(s) of the passenger(s) agree and accept all liability.

Please understand we love your son/daughter and are concerned for his/her safety. We want you to know that your son/daughter arrived on time and is safe. Thank you!

Reason for Time Away:

(Please refer to the policies in the HBA Athletic Handbook if you will be in-season during the time of the camp.)

Student will be:

Date

Time

Departure Date & Time

Return Date & Time

How will the student be traveling to/from camp?

Who will be dropping off and/or picking up the student?

Medical Limitations*

Does your child have any medical or physical limitations that may require special care, accommodations, or instructions?

Yes No

Describe the medical/physical/other limitation:

Accommodations required:

Additional Information/Specific Instructions:

The following person is authorized to act on my child’s behalf, if I cannot be reached in an emergency.

Emergency Contact's First & Last Namerequired

Phone Numberrequired

###-###-####

Relationshiprequired

Authorization*

I authorize a staff or faculty member of HBA to transport or coordinate transportation of my child to a medical facility and to allow the on-duty medical professionals to administer first aid, care, and treatment. I understand that HBA, its related entities, agents, directors, advisors, officers, representatives, and all other persons acting on behalf of HBA (collectively, "HBA") does not assume any responsibility for or obligation to provide financial assistance or other assistance, including but not limited to medical, health or disability insurance. I hereby release and forever discharge HBA from any claim whatsoever which arise or may hereafter arise on account of any first aid, treatment, or service rendered to my child.

Yes No

Digital Signature Consent*

You agree and consent that your use of a key pad, mouse or other device to select an item, button, icon, checkbox, to enter text, or to perform a similar act/action (e.g., by clicking “Submit”) constitutes your electronic signature and signifies your intent to be bound. You understand that your electronic signature is legally binding, just as if you manually signed a paper document in ink.

Yes No

Parent Signaturerequired

Type Your Full Name

Daterequired (mm/dd/yyyy)

Please send a confirmation email to the address below*: