4068 Oakmont Dr., Pontoon Beach, IL, 62040

618-501-4141

BBNS Academy

Building Brilliant kNowledgeable Scholars

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Summer Program
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Home
Our History
Our School
Summer Program
Photos
Testimonials
Community
Give/Donate
Contact Us

Limited Openings Are Available
Apply Now it is Not Too late!
Register for the Summer Program Below!

Fees Include:

Activities,

Food,

Snacks,

Educational Curriculum,

Transportation*,

Supplies, and

MORE!

We are happy to announce that we have the lowest rates for a summer program in the Metro-East Area.

CHASI & DCFS PAYMENTS ACCEPTED

ONLINE REGISTRATION FORM

Enroll in our 2022 Summer Program!

Child's First and Last Name*

Gender*

Age*

Date of Birth*

Grade*

Home Address*

Child's Shirt Size*

Youth XSYouth SYouth MYouth LYouth XLAdult SAdult MAdult L

Will you be needing transportation?*

YesNo

Parent/Guardian Name*

Parent/Guardian Address

Parent/Guardian Email Address

Parent/Guardian Cell Phone Number*

Parent/Guardian Work Phone Number

OTHER THAN YOU, who is able to pick up your child(ren).*

(Name, Relationship to child, Address, Phone)

Child's Medical Information

(Insurance Company, Member/Policy Number, Policy Holder Name, Employer Name)

Emergency Contact*

(Name, Phone Number)

My Child has permission to fully participate in BBNS Academy's Summer Program Activities during the 2022 summer term.*

YesNo

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*

YesNo

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.*

YesNo

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.*

YesNo

I hereby agree to sign an electronics waiver upon registration.*

YesNo

We will follow up with you, what date are you available?

We will follow up with you, what time are you available? Thank you!

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Fill out this submission form to apply for our Summer Program, and a staff member will be with you shortly. If you would like, you can even set a time and date for us to call you!

REGISTRATION FEE: $30

(THIS FEE COVERS REGISTRATION AND SUMMER PROGRAM T-SHIRT).

618-501-4141

[email protected]

Limited Openings Are Available Apply Now it is Not Too late! Register for the Summer Program Below!

Enroll in our 2022 Summer Program!

Limited Openings Are Available
Apply Now it is Not Too late!
Register for the Summer Program Below!