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Heritage Christian Academy A Pre-Kindergarten through 12th Grade School
15655 Bass Lake Road, Maple Grove, MN 55311 / 763-463-2200 / www.heritageweb.org
2019
Equipping Minds
Engaging Hearts
Encountering Jesus Christ
You’ll Love Summer At HCA
How to Register:
Please see each summer offering for specific instructions on how to register.
Signing up for one or more Athletic Camps?
Turn in one Athletic Registration Form for all the camps.
Not a student at HCA? You must fill out the waiver form and
return it to HCA to participate in any of our summer offerings.
Dear Heritage Families,
It’s hard to believe summer is right around the corner!
Summer months are often a great time to sharpen and
further academic and athletic skills. I’m pleased that HCA
will be providing elementary, middle and high school
families enrichment opportunities for their children.
Our summer program includes classes such as Coding,
Robotics, Safeway Driving School, STEAM opportunities, Camp Kindergarten, and
First Grade Frenzy, along with our annual spectrum of athletic camps. Summer
tutoring sessions, designed to meet the individual needs of students, will also be
available for middle and high school students. All of these events will be taught by
qualified and skilled professionals.
Each summer enrichment opportunity is designed to be meaningful and fun! Our
highly trained teachers and coaches are looking to present important spiritual,
social, academic, music, and athletic skills in the context of enjoyable summer
activities.
I look forward to summer’s bustle of activity and excitement that learning will bring
to students, parents, teachers and coaches at Heritage this summer.
For Christ and His School,
Tonya Scott
President
Heritage Christian Academy
From beginners just learning the mechanics of the game to the more advanced player, this camp provides an oppor-tunity to grow as a com-plete soccer player.
The function of this camp is to enable each boy and girl to reach his or her full potential. Within a pre-established sequence of progression, individual skills will be polished.
This camp is centered around sharing the Gospel of Jesus Christ while teaching the game of soccer. Our staff will lead the campers in devotions and prayer throughout the week.
When: May 28-31, 9:30am-12:00pm Where: HCA Soccer Field or Gym Cost: $100-Make check payable to HCA Led by: Coach Chris Laird Register by contacting: Lori Crellin, Associate Athletic Director 763-463-2204, [email protected] Participants must fill out the HCA Summer Sports Camps Application
Elementary Soccer Camp May 28-31 Grades 1-5 in fall of 2019
MS & HS Soccer Camp June 3-6 Grades 6-12 in fall of 2019
Love the game of soccer? Then this camp is for you!This camp will help beginners to the most ad-vanced players hone their skills. In addition to learning more about this great game each day will also include, devotions and prayer. When: June 3-6, 9:30am-12:00pm Where: HCA Soccer Field or Gym Cost: $100-Make check payable to HCA Led by: Coach Chris Laird Register by contacting: Lori Crellin, Associate Athletic Director 763-463-2204, [email protected] Participants must fill out the HCA Summer Sports Camps Application
KidzArt : June 3-6 STEAM Ooey, Gooey, Messy Art & Science Grades 1-5 in fall of 2019
Looking for a colorful, exciting and a bit messy summer? Challenge your brain with KidzArt and Science Explorers in this hands-on, inquiry-based camp. With over 30 years of experience, our programs will give your child a week of fun, educational and wonderful memories. During this full day art/science camp students will split their day between KidzArt and Science Explorers. When: June 3rd-6th 9am-3pm Where: Room #128 Cost: $200-Make check payable to KidzArt Register by contacting: Lisa Vitkus 763-494-6957 [email protected]/ nwmpls.kidzart.com
Safeway Driving School is the largest driving school in Minnesota, instructing over 6500 teens this year. Their goal is to educate students to become safe and skillful driv-ers. Before obtaining a driver’s license, Minnesota law requires all persons under 18 years old to attend 30 hours of classroom training and receive 6 hours of behind the wheel instructions. For your convenience, you may take the classroom part of the training at HCA at a special rate. When: June 3-6 June 10-13 June 17 & 18 9:15am-12:15pm Where: Room #231 Cost: $390 upon registration or $400 payment plan Register by contacting: Students must register online with Safeway Driving School at www.safewaydrivingschool.com Contact: 651-351-9150
Safeway Driving School June 3-18 Must be 14 1/2 by the first day of school
At Basketball Camp, you will learn the FUNdamentals of basketball-including rules of the sport, how to dribble, pass, and shoot the basketball, as well as learn about the history of the game. Oh, and did we mention that it will be A LOT OF FUN too! When: June 10-13, 9:00am-12:00pm Where: HCA Gym Cost: $100-Make check payable to HCA Led by: Coach Tim Herman & Coach Lori Crellin Register by contacting: Lori Crellin, Associate Athletic Director 763-463-2204, [email protected] Participants must fill out the HCA Summer Sports Camps Application
Elementary Basketball Camp June 10-13 Grades 1-5 in fall of 2019
This camp will teach you new skills and help you improve the basketball skills you already have. Fun will be had by all and you will come away from the camp feeling more confident about your game! When: June 10-13, 1:00-4:00pm Where: HCA Gym Cost: $100-Make check payable to HCA Led by: Coach Tim Herman & Coach Lori Crellin Register by contacting: Lori Crellin, Associate Athletic Director 763-463-2204, [email protected] Participants must fill out the HCA Summer Sports Camps Application
Middle School Basketball Camp June 10-13 Grades 6-8 in fall of 2019
In this incredible camp, students jour-ney from the tropics to the poles, inspect arc-tic food webs, simu-late coral reef adapta-tions and survey eve-rything from the great river deltas to the Mariana Trench. They collaborate to bring the Cali-fornia sea otter back from the brink of extinction and track great white sharks across the open ocean, learning and answering important sea-dwelling questions about the variety of the oceans and the differences in ecosystems. Through action-packed activities, learners discover the physical and geological sciences that underpin all ocean life like density, buoyancy, heat transfer, plate tecton-ics and the water cycle. In Ocean Exploration Camp, STEM education is your oyster! When: June 10-13, 9:00am-12:00pm Where: Room #233 Cost: $120 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
Engineering for Kids: June 10-13 Ocean Exploration Grades 3-6 in fall of 2019
Engineering for Kids: June 10-13 Magic Beans Grades K-3 in fall of 2019
From Jack and the Beanstalk to the gold-en touch of King Midas, fairy tales have always engaged and captured imagina-tions. In Magic Beans, exotic, far-away lands, magical powers and the eternal theme of good versus evil come to life in thrilling engineering, language arts and collabora-tive communication challenges. Inside the world of princesses and wizards, students boost fluency, vocabulary and comprehension as they act out dif-ferent folktales. Engaging in manipulative-based engineering activities, they’ll work together to build the characters and stage props needed throughout camp. Every day, sprinkle in some imagination, a handful of magic and let fiction fly in Magic Beans Camp. When: June 10-13, 1:00-3:00pm Where: Room #233 Cost: $110 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
Golf Camp June 17-20 Grades K-4 in fall of 2019
Tee it up at golf class and discover how fun and ex-citing golf can be with TGA! Coaches lead students through station-based drills and games that develop the fundamental skills of grip, chipping and full-swing. Students participate in STEAM labs that al-low them to explore academic concepts like gravity, force, and spin through the game. Equipment and training materials are provided. When: June 17th-20th, 9:00am-12:00pm Where: Near Soccer Field or Gym Cost: $159 Register by contacting: TGA at www.playtga.com/chc Questions contact: Alexandra Tegels at 507-993-6377 or [email protected]
Tennis Camp June 17-20 Grades K-4 in fall of 2019
Serve it up with tennis class and discover how fun and exciting tennis can be with TGA! Coach-es lead students through station-based drills and games that develop the fundamental skills of grip, forehand, backhand, vol-ley, and serve. Students participate in STEAM labs that allow them to explore academic concepts like gravity, force, and spin through the game. Equip-ment and training materials are provided When: June 17th-20th, 1:00-3:00pm Where: Near Soccer Field or Gym Cost: $135 Register by contacting: TGA at www.playtga.com/chc Questions contact: Alexandra Tegels at 507-993-6377 or [email protected]
Tech Academy: June 17-20 Extreme Robotics: EV3 Robotics Tournament Grades 5th-8th in fall of 2019
New Class with new builds and challenges! Take your engineering skills to a higher level. Students will be using the EV3 Mindstorm Robotics Systems, and special Lego Technic engineering components to build extreme competitive robots. Students will be working in small teams to control their robots with EV3 programs. Students will then have the chance to modify the programs and builds. Students will be challenged to morph their projects in better, stronger and faster robots to compete in a Tournament on the last day. Please bring a drink and snack daily. When: June 17-20, 9:00am-12:00pm Where: Room #233 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
*98% of HCA grads pursue post-secondary education
*100% HCA graduation rate
*100% HCA college entrance exam-takers consistently averages 5-6 points higher than
the national ACT average
*85% of HCA fine arts students are also HCA athletes
*100% HCA teachers love and model Jesus Christ to their students every school day. This equals 1190 hours /71,400 minutes/4,284,000 seconds of discipleship training for your child.
*21% HCA staff hold at least one masters degree.
ROAR This epic African adventure engages the whole herd. As Roar, kids explore God’s goodness and celebrate a ferocious faith that powers them through this wild life. Who: Grades K-6 When: June 25-28, 9:00am-12:00pm Where: HCA Cost: Offering taken daily Register by contacting: Grace Free Lutheran Church 763-463-2300
GFLC Vacation Bible School June 24-28 Grades K-6th Grade in fall of 2019
Tech Academy: June 24-27 Minecraft Designer: Dungeons Grades 1st-5th in fall of 2019
Don't just play Minecraft! Turn Minecraft from a game into a visual learn-ing tool! This class will reinforce problem-solving skills and spatial cognition through learn-ing to create in-game dungeons and treasure maps. This class has a strong emphasis on creativity, ex-ploration, and cooperative learning experiences. While immersed in the fun and creative world of Minecraft, students will learn about concepts in pro-gramming and game design. When: June 24-27, 12:30-3:00pm Where: Room #231 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Heritage's Social Media Audience Is Growing!
Find HCA on Facebook,
Instagram, and Twitter.
#GOHCAEagles
Chess Camp July 8-11 Grades K-8 in fall of 2019
Challenge Yourself! Exercise Your Brain! Play Chess! Master this timeless classic battle of strategy. Nothing prepares you for critical thinking better than chess! When: July 8-11,9:00am-3:00pm (bring a bag lunch & drink) Where: HCA Room #114 Cost: $129 make checks payable to Twins Cities Chess Register by contacting: Twin Cities Chess Irina Rybakova, 952-457-4800, [email protected]
KidzArt July 22-25 Clay Creations and More! Grades K-5 in fall of 2019
There are many little ways to enlarge your child’s world.
Love of books is the best of all.
Engineering for Kids: July 22-25 60 Seconds or Less Grades 5-8 in fall of 2019
In this action-packed camp, Students channel their inner competitive spirit to complete 60 second chal-lenges that reinforce specific STEM principles. From exploring energy conservation by rolling mar-bles over tape to understanding the power of air pres-sure by making cups fly, each day, learners utilize household items and micro-challenges to demon-strate the expansive world of STEM. As the challeng-es in 60 Seconds or Less Camp become progressive-ly more difficult, students need to think fast, move quickly and apply the real-world principles they’ve learned in order to earn the honor of being called a true STEM champion! When: July 22-25, 9:00am-12:00pm Where: Room #136 Cost: $120 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
Tech Academy: July 15-18 Robotic Builders: Battlebots Grades 1-5 in fall of 2019
Let the battles begin! Designed by the experts at M.I.T., LEGO WeDo Robotics’ unique system teaches students about simple machines, engi-neering, programming, and so much more. In this camp, students may construct a Catapult, Ninja Star, Tank, Battle Axe, Crossbow, and more! Please bring a drink and snack daily. When: July 15-18, 12:00-3:00pm Where: Room #134 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Do you love to build and construct with clay? Then join KidzArt as we ascend to new heights building excit-ing 3-D sculptures us-ing a variety of kinds of clay including air-dry, model magic, and Sculpey! We will also try making sculptures out of new, found, and repur-posed materials to create free-standing sculptures, mobiles, and wall assemblages. When: July 22-25 9:00-11:00am Where: Room #120 Cost: $105-Make check payable to KidzArt Register by contacting: Lisa Vitkus 763-494-6957 [email protected] nwmpls.kidzart.com
Learn to create an interactive 2D video game using your FAVOR-ITE characters. Choose charac-ters from Undertale, Pokémon, Nintendo, Minecraft, and even classic characters like Donkey Kong, Pac Man, Sonic, and Mario! In the first classes, we will learn to use Scratch, and in the final session, students will be walked through creating a maze game and pick-ing which main character to use. Bring a USB drive to save your games on the last day, or they can be emailed to parents. When: July 29-August 1, 9:00am-12:00pm Where: Room #236 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Engineering for Kids: July 22-25 Zoo Camp Grades K-3 in fall of 2019
Tech Academy: July 29-August 1 Battle Royale Game Coding Grades 5-8 in fall of 2019
Join us for an exciting week of game coding! Create your own battle royale game for you and your friends to drop in to. Customize the map, set your characters, and create upgrades to scatter across the world by learning coding and game design. Use your skills to achieve a Victory Royale. Please bring a drink and snack daily. Bring a USB drive on the last day to save your games, or they can be emailed to par-ents. When: July 29-August 1, 12:30-3:00pm Where: Room #236 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Traverse tricky terrain, shake claws with lobsters and design ecosystems in this life science camp! Dis-cover the diversity of wild-life adaptations, the differences in habitats and what’s necessary for each biome’s survival. Focusing on specific environments, students travel from the sands of the Sahara to the peaks of the Himalayas in search of unique and complex crea-tures. Zoo camp delivers an engaging, hands-on experience around the Earth’s biospheres and the vital roles animals play in them. When: July 22-25, 1:00-3:00pm Where: Room #136 Cost: $110 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
Tech Academy: July 29-August 1 Into to Game Coding Grades 1-4 in fall of 2019
Engineering for Kids: August 5-8 Traveling Artists Grades 3-6 in fall of 2019
Survey the world of art by carv-ing totem poles in the Pacific Northwest, crafting Aztec masks in the heart of Mexico and experimenting with the ar-tistic traditions of history. In this thrilling camp, students get cre-ative examining the STEM pro-cesses that make art possible, like the delicate balance of wa-ter tension involved in Japa-nese Suminagashi paper or the cultural traditions and paleontology of Chinese “dragons”. This camp was developed by an artist and art educator in order to embody the true insight of a creative mind. In Traveling Artist Camp, explore the different cultures of the world through the depth of their history, legacy and incredible works of art! When: August 5-8, 9:00am-12:00pm Where: Room #215 Cost: $120 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
BATTLE
ROYALE
Tech Academy: August 5-8 Java Minecraft Modding-Infinity Gauntlet Grades 4-7 in fall of 2019
Learn and use elements of Java coding to create Minecraft mods. Alter the world around you with the real stone, defeat the ender dragon with the power stone, and halve the universe using all six infinity stones. Shape the world to your will and make the universe “perfectly balanced”. Use the Java pro-gramming language to create Thanos armor and a working infinity gauntlet. Students should be com-fortable with keyboarding and, of course, playing Minecraft! At the end of class, take home your mods to share with family and friends. Bring a USB drive, a snack, and a drink each day. When: August 5-8, 12:00-3:00pm Where: Room #217 Cost: $135 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Tech Academy: August 5-8 Jr. Engineering: Crazy Gears and Wheels Grades K-2 in fall of 2019
If you love LEGOs, making things move, building, and ex-perimenting – this class is for you. Learn about engineering and the physical science princi-ples behind different action ma-chines. Working in teams, stu-dents will build crazy wheeled and geared contraptions that spring into action. Have fun while you learn the principles of mechani-cal engineering and simple machines. Make tops, spinners, zip lines, rubber band-powered cars, crimping cars, and other crazy contraptions. Please bring a drink and snack daily. When: August 5-8, 9:00am-11:30pm Where: Room #215 Cost: $120 Led by: Tech Academy Register by contacting: Ryan Gilman [email protected] www.techacademymn.com/HCA 651-730-9910
Engineering for Kids: August 5-8 Sports Science Grades K-3 in fall of 2019
With near-perfect pitches, swings, kicks, strokes and sprints, an athlete’s skills come down to countless hours of prac-tice and a whole lot of science. Designed to excite students by bringing STEM into their favorite activities, this camp thrives on action-packed learning experi-ences. Each day, learners investigate the me-chanics of a different movement, connecting STEM concepts, like force, motion and the influ-ence of gravity, to the movement of their own bodies. What does friction have to do with soc-cer? Why would a football player need to know about unbalanced forces? How would an Olympi-an hold up against a kangaroo in the long jump? Answer these questions and so much more in Sports Science Camp!
When: August 5-8, 1:00-3:00pm Where: Room #215 Cost: $110 Register by contacting: Armando or Ria Mojica at 763-473-0362 www.engineeringforkids.com/mpls [email protected] Special instructions: Please bring water and a nut-free snack.
Hand Bell Camp August 12-15 Grades 3-8 in fall of 2019
This camp is designed for stu-dents with very little experi-ence ringing handbells. We will learn the “healthy” way to ring handchimes, basic note reading, counting/rhythm skills and note tracking. By the end of the week you will be playing 2-3 songs. A parent may join their child. When: August 12-15; 10:00-11:30am Where: Room #127 Cost: $100 per student, if a parent joins their student, $50 for the parent. Make check payable to: Mary Yerks Led by: Ms. Mary Yerks and Mrs. Leslie Cryer Register by contacting: [email protected] Special instructions: You may bring a water bottle.
Summer Lessons & Tutoring
Mr. Matthew Kinne What: Music: Voice, Any Beginning-Intermediate Band Instrument, Advanced Trumpet, Gui-tar. Who: Students or Parents of any age When: Contact Mr. Kinne for dates and times options Where: Band Room Cost: $30 per 30 minute lessons Make checks payable to: Matthew Kinne Register by contacting: 952-220-6459, [email protected] Mrs. Carin Laird What: Language Arts Tutoring (Reading comprehension, writing, language usage, ACT prep) Who: 6-12 graders When: Monday-Thursday, end of June-mid-August Where: Room #232 Cost: $30 per hour Make checks payable to: Carin Laird Register by Contacting: [email protected] Ms. Mary Yerks What: Any band instrument - grades 5-7, woodwinds-grades 5 -12, strings - grades 4-7 Who: Open to HCA and Non-HCA students When: June - August; lesson time will be scheduled at a day and time agreed upon by the student and teacher. Where: Room #129 Cost: $30 per ½ hour lesson Make checks payable to: Mary Yerks Register by Contacting: [email protected] 769-226-9058 [email protected] Special instructions: You may be requested to purchase a book that will be less than $20.00. You may bring a water bottle.
You don't want to miss out on this year's First Grade Frenzy! First grade frenzy is a fun and educational oppor-tunity for your incoming first graders to get a better feel for what first grade is all about. Come join us for hands on learning activities, introductions to new classmates and both teachers, and most important-ly, gaining a new excitement for the fun-filled year ahead! We will be going through aspects of a typical day in first grade and get the kiddos comfortable with the routines and subject content. I can't wait to spend time with your students and have a wonderful kick-off to the 2019-2020 school year! When: 3 Day Camp, August 14-16, 12:30-3:30pm Where: Rooms #124 and #126 (Meet in room #126 first day) Cost: $100-Make check payable to Janaya Gurewitz Led by: Mrs. Gurewitz and Miss Schallenkamp (1st Grade Teachers) Register by contacting: Mrs. Janaya Gurewitz [email protected] Special instructions: Please send a snack and water bottle with your child each day.
First Grade Frenzy August 14-16 Grade 1 in fall of 2019
Camp Kindergarten offers students a head start on kin-dergarten math and phonics, as well as practicing new routines. Students are also introduced to their perspec-tive teacher during a fun, get to know you session. An important part of Camp Kindergarten is building relationships and beginning the process of learning to serve one another in love. Camp Kindergarten is a great way to build excitement for school, and wash away their anxieties about starting kindergar-ten. Don’t miss out! Who: Students entering Kindergarten in fall of 2019 When: August 12-15, 9:00am-12:00pm Where: Room #120 Cost: $160 Make check payable to Kathy Shapiro Register by contacting: Mrs. Kathy Shapiro (Kindergarten Teacher) [email protected]
Camp Kindergarten August 12-15 Kindergarten in fall of 2019
HERITAGE CHRISTIAN ACADEMY
Event Permission and Waiver Form NON HCA STUDENTS MUST FILL OUT THIS WAIVER TO PARTICIPATE IN ANY OF THE
SUMMER ENRICHMENTS OFFERED IN THIS CATALOG.
Please attach additional medical/health information including doctor’s notes and medication notifications.
I grant permission for my Child, ________________________________________, (“Child”) to participate in co-
curricular (related to curriculum, required course requirements or educational requirements) and extra-curricular
(voluntary activities unrelated to course requirements or curriculum) activities at Heritage Christian Academy
(“HCA”), HCA sponsored events and Minnesota State High School League sponsored events (“Events”), including,
but not limited to, intramural and interscholastic events, music contents, athletics, fieldtrips, and transportation to
and from the Events. In order to allow my Child to participate in these Events, I, Individually, and as a parent, or
legal guardian of my Child agree to the following:
Waiver : In consideration of permission to par ticipate, today and on all future dates I, for myself, my Child,
my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue HCA,
their directors, officers, employees, coaches, instructors, and agents from liability from any and all claims, not in-
cluding claims related to gross misconduct, related to personal injury, accidents or illnesses (including death), and
property loss arising from, but not limited to, my Child’s participation in extra curricular activities, classes, observa-
tion, and use of facilities, premises, or equipment at HCA or at any Event, off HCA’s premises.
Assumption of Risks: Cer tain activities, including but not limited to athletic events, transpor tation to and
from Events, whether by HCA transportation or bus service, by its very nature, carries with it certain inherent risks
that cannot be eliminated regardless of the care taken to avoid injuries. HCA has facilities for and provides for ac-
tivities conducted on its’ property or access and transportation to facilities that involve travel and or physical activi-
ty. I acknowledge that HCA is not warranting the condition of any of the facilities or granting assurances of an ex-
pected result due to use of the facilities whether at HCA or the location of the Event. HCA may not have any con-
trol over the conditions present at an Event, nor does it have control over the actions of your Child or other Children
participating in the Event, whether they are fellow HCA students or non-HCA students. I acknowledge that my
Child may have known or unknown pre-existing medical conditions that may impact his/her ability to participate in
Events or use certain facilities and equipment properly. I acknowledge that my Child is a guest and by signing this
waiver, I assume all responsibility for my Child’s own behavior and any impact or harm which may come to the
Child, or to another person due to my Child’s actions.
Indemnification and Hold Harmless: I agree to indemnify and hold Her itage Chr istian Academy and their
directors, officers, employees, coaches, instructors and agents harmless from any and all claims, actions, suits, pro-
cedures, costs, expenses, damages and liabilities, including attorney’s fees, brought as a result of my Child’s in-
volvement or asserted in connection with an Event and to reimburse them for any such expenses incurred to the
fullest extent of the law.
Child’s Name: Age:
Birthdate: Parent(s)/Guardian(s) Name(s):
Telephone: Secondary Contact: Telephone:
Allergies: Health Conditions:
Severability: The undersigned fur ther expressly agrees that the foregoing waiver and assumption of r isks
agreement is intended to be as broad and inclusive as is permitted by the law of the State of Minnesota and that if any
portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and ef-
fect.
Medical Treatment: I hereby author ize any medical treatment deemed necessary for my Child in the event of
any injury or illness while participating in an activity or at an Event and the administration of any medication pre-
scribed by a medical doctor. My Child either has appropriate insurance or, in its absence, I agree to pay all costs of
rescue and/or medical services as may be incurred on my Child’s behalf. Please note that during Events, there may be
no one available to administer medications to students. Should medication be necessary at these times, it is the
parent’s responsibility to administer and exceptions will be made ONLY for those students for whom self-
administration is necessary and who have secured approval through filing of the necessary medication forms in the
school office. In the event of an emergency, I fully authorize the administration of life-saving measures, and the utili-
zation of emergency services in the judgment of HCA.
Authorization: I have read this waiver of liability, assumption of r isk, and indemnity agreement. I fully under -
stand its terms, and understand that I am giving up substantial rights, including certain legal rights. I acknowledge
that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional
release of all liability to the greatest extent allowed by law on my behalf and on behalf of my Child. I hereby assert
that my Child’s participation is voluntary and that I knowingly assume all such risks for my Child. I understand that
Events may be supervised and provided by persons who are not employees, faculty or staff of HCA. I further under-
stand that Events may be separate and unrelated to regular day course studies at HCA and are offered only as enrich-
ment opportunities for students.
THIS ACKNOWLEDGMENT MUST BE SIGNED BY THE PARENT(S) WHO HAVE LEGAL CUSTODY OF THE
CHILD PARTICIPATING IN HCA EVENTS. BY SUBMITTING THIS SIGNED FORM, THE PARENT(S) CONSENT
TO THIS AGREEMENT AND ACKNOWLEDGE THAT ALL PARENTS OR GUARDIANS WITH LEGAL CUSTODY
HAVE APPROVED THIS AGREEMENT.
Dated:
Parent/Guardian
Dated:
Parent/Guardian
For Administrative Purposes Only
Dated Received: Medical/Health/Allergies: Last Name:
Received By: Additional Forms Attached: Homeroom Teacher:
Heritage 2019 Summer Sports Camps Application
All camps are either in the HCA Gymnasium or on the HCA Soccer Field
Fill out Application Form per student: Check the camps your child is attending. Elem. Soccer Camp (1st -5th in the fall 2019), May 28-31, 9:30am-Noon Cost: $100
MS/HS Soccer Camp (6th -12th in the fall 2019), June 3-6, 9:30am-Noon Cost: $100
Elem. Basketball Camp (1st -5th in the fall 2019), June 10-13, 9am-Noon Cost: $100
Middle School B-ball Camp (6th -8th in the fall 2019), June 10-13, 1pm-4pm Cost: $100
Need Soccer ball Cost: $ 20
MUST register 2 weeks PRIOR to first day of Camp. If not, add $25.00 fee
Cost: $ 25
Total Cost: ___________
Make check payable to HCA. Send to: HCA Athletic Office Questions: Lori Crellin, Associate Athletic Director Phone: 763-463-2204 Email: [email protected]
Student Name: _________________________ Grade: (fall 2019) ________ HCA Student Non HCA Student School Name:_______________ (HCA Waiver must be included)
T-Shirt Size: (please circle one) Youth: XS S M L XL Adult: S M L XL
Full Address: _________________________________________________ Parent Name: _______________________ Emergency Phone:__________ Parent Email: _________________________________ Special Medical Concerns we should know:__________________________
____________________________________________________________
We/I hereby release HCA and the listed staff per camp of all claims on account of any inju-ries, which may be sustained by our/my child while attending a camp. We/I also certify that the child is medically fit to participate and are responsible for any insurance coverage. We/I hereby authorize the staff of the above Heritage Camps to act for us/me according to their best judgment in an emergency requiring medical attention. Please have ALL Guardians sign below.
____________________________ ______________________________ (Signature of Mother/Guardian) (Signature of Father/Guardian)
What to Wear/Bring: (if applicable) Appropriate shoes (soccer cleats, indoor gym shoes that are non-marking soles – never worn outside), shin guards, soccer ball, water bottle, healthy snack, and sunscreen.
HCA'S 2019
ALL SCHOOL
HELLO ACADEMY NIGHT!
MONDAY, AUGUST 26th
MARK YOUR
CALENDAR
NOW!
Heritage Christian Academy Preschool –Grade 12
For enrollment information call 763-463-2223 TODAY!
