FBA Summer Camp

Parent/Guardian Information

Father's Name

Mother's Name

This address will receive a confirmation email

Phone

Address

Student Information

Last Name

First Name

Grade

Gender

Birthday

Pick Up and Emergency Contacts

Contact 1

Relationship

Phone Number

Contact 2

Relationship

Phone Number

Medical Information

Family Insurance Company

Policy Number

Known Medical Conditions

Known Allergies

General Information

How did you hear about FBA Summer Camp?

Has your child ever been dismissed from a camp or school before?

Does your child have reoccurring behavioral issues?

What church do you attend regularly?

Shirt Size

Short Size

I hereby grant permission for my child to attend off-campus activities sponsored by First Baptist Academy Summer Camp. I also acknowledge that First Baptist Church of SW Broward and First Baptist Academy are not responsible for injury or loss of personal belongings on these trips. My child and I understand that if they do not follow directions, they can be sent home at the director’s discretion and they will not receive a refund. In the event that my child becomes ill or injured while under the camp’s supervision, I authorize the leader or their designee to take the following steps:1. Contact the parents of the child IMMEDIATELY and follow his or her instructions. 2. In the event that neither parent can be reached, FBA will contact the 2 (two) emergency contact and/or the child’s physician and pro- ceed as instructed by the aforementioned. In the event that these contacts cannot be reached, FBA will call 911.3. If the child needs emergency medical services which require parental consent, and the parents cannot be reached, I, the parent hereby authorize, appoint, and empower the director, or the staff designee to furnish on my behalf such written or oral authorization as may be required. 4. I release the director or staff designee or designees , FBA and First Baptist Church from any liability which might arise from the granting of such authorization, as it is my desire that my child receive medical attention as soon as possible. 5. I give permission for the participant’s picture, while participating in camp activities, to be used in brochures, publications, slides and videos promoting FBA Summer Camp. 6. I agree to keep all camp payments up to date. I understand that my child will not be allowed to participate in FBA Summer Camp with any outstanding balance.

Registration Fee

Registration fee includes one camp shirt, one pair of camp shorts, transporation cost, activity supply cost (archery, STEM, crafts, baking, computer lab). REGISTRATION FEE IS NONREFUNDABLE!

Registration Fee 75

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

FBA Summer Camp

Description

Please Fix the Following