Summer Camp Registration

Child(ren)

Child's Name(Required)

First Middle Last

Child's Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Gender(Required)

As determined by birth and not change nor identity.

Male

Female

Child's Birthday(Required)

Child's Grade Level(Required)

Grade Level should reflect the 2024-2025 school year.

Do you wish to register a second child?(Required)

You must be the parent of this child.

Yes

Child's Name (#2)(Required)

First Middle Last

Child's Physical Address (#2)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Gender (#2)(Required)

As determined by birth and not change nor identity.

Male

Female

Child's Birthday (#2)(Required)

Child's Grade Level (#2)(Required)

Grade Level should reflect the 2024-2025 school year.

Do you wish to register a third child?(Required)

You must be the parent of this child.

Yes

Child's Name (#3)(Required)

First Middle Last

Child's Physical Address (#3)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Child's Gender (#3)(Required)

As determined by birth and not change nor identity.

Male

Female

Child's Birthday (#3)(Required)

Child's Grade Level (#3)(Required)

Grade Level should reflect the 2024-2025 school year.

Parents

Mother's Name(Required)

First Middle Last

Mother's Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mother's Email

Mother's Home Phone

Mother's Cell Phone

Mother's Work Phone

Mother's Place of Work

Father's Name(Required)

First Middle Last

Father's Physical Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Father's Email

Father's Home Phone

Father's Cell Phone

Father's Work Phone

Father's Place of Work

Who do you prefer we contact first?(Required)

Mother

Father

Emergency Contact(s)

Emergency Contact (#1)(Required)

Also authorized to pick up child.

First Name Last Name

Emergency Contact (#2)(Required)

Also authorized to pick up child.

First Name Last Name

Emergency Contact (#1)(Required)

Emergency Contact (#2)(Required)

Emergency Contact (#1)(Required)

List the best phone number to reach the emergency contact.

Emergency Contact (#2)(Required)

List the best phone number to reach the emergency contact.

Additional Person(s) Authorized to Pick Up Child

Additional Person Authorized to Pick Up Child (#1)

First Name Last Name

Additional Person Authorized to Pick Up Child (#2)

First Name Last Name

Additional Person Authorized to Pick Up Child (#1)

Additional Person Authorized to Pick Up Child (#2)

Additional Person Authorized to Pick Up Child (#1)

List the best phone number to reach the additional person authorized to pick up child.

Additional Person Authorized to Pick Up Child (#2)

List the best phone number to reach the additional person authorized to pick up child.

Authorizations & Compliance

Comments

Additional Comments

Signature

Signature(Required)

Printed Name

Date(Required)

hCaptcha(Required)

Complete the below form to register for Summer Camp at FCA!

Child(ren)

Parents

Emergency Contact(s)

Additional Person(s) Authorized to Pick Up Child

Authorizations & Compliance

Comments

Signature