4068 Oakmont Dr., Pontoon Beach, IL, 62040

[email protected]

618-501-4141 

                   

BBNS Academy

Building Brilliant kNowledgeable Scholars

BBNS Academy Enrollment Form 2022-2023

Put in the last 4 of your child's Social Security Number
(123 ABC Lane, My City, IL, 12345)
Child's Shirt Size*
Will your child need transportation?*
(First and Last name)
(123)456-7890
(123)456-7890
(Name, Relationship to Child, Address, Phone)
(Name, Relationship to child, Address, Phone)
(Allergies, Medications, Insurance Company, Member/Policy Number, Policy Holder Name, Employer Name)
(Name, Phone Number)
I authorize BBNS Academy to use a photograph or other image of my child for public relations purposes connected to the summer camp program and future programs associate with BBNS Academy*
I hereby give permission to BBNS Academy for my child(ren) to participate in excursions involving transportation and consent to give BBNS Academy permission to transport my child for program purposes.*
I agree to a financial contract that will be established between myself and BBNS Academy and hereby set the enrollment date as the one discussed with staff. I agree to physically sign a financial agreement as well.*
I hereby agree to sign an electronics waiver upon registration.*
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