FSBC Kid's Camp 2025

Camper Information

Camper Name

Gender

Boy Girl

Birth Date

Age at the time of the camp

Preferred group

Please select any age groups that are acceptable for your child.

Boy Groups Age 13-15 Age 11-12 Age 9-10 Age 7-8

Girl Groups Age 13-15 Age 11-12 Age 9-10 Age 7-8

Cabin Buddy

List first and second choice, not all requests guaranteed

Cabin Buddy #1

Cabin Buddy #2

Parent Information

Parent Name

This address will receive a confirmation email

Phone

Address

What is your home church?

Emergency Contact

Name and Phone number of the Emergency Contact, other than the parent

Health Information

It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the health officer at that time. Please bring all medication in ORIGINAL CONTAINER or you will not be allowed to leave the medication or vitamins at the camp. No exceptions. All prescriptions must be in that campers name and the correct dosage.

Any activity the camper should be restricted from?

Any physical, mental or other condition that would require special attention or medication while at camp?

List any allergies (bees, peanuts, dairy)

List all medications, both prescribed and over the counter, all medications will be turned into the health officer except rescue inhalers, bring all medication in original containers.

Any dietary needs that we should know about?

Does camper eat Slavic homemade food, such as borscht, soup, kotleti, grechka, etc.

Please describe your child. His likes, dislikes, fears, strengths, etc.

What language does your child understand or fluent at?

What are your suggestions to camp staff? Comments? (optional)

On the scale of 1 to 5, how excited your child to go to FSBC Summer Kids Camp? (Please answer honestly, it will not be used against you.)

1 - Not excited about going to camp yet 2 3 4 5 - Super excited to go to this camp

Camper Release

Parents must arrange to bring their camper to kids camp on Saturday, August 2nd between 3pm (not earlier) and 5 pm. All campers must be picked up by 10:00 am on Thursday, August 7th. We do not offer transportation at this time.

List anyone, including parents, to whom your camper can be released

Consent to Attend Event: I hereby give permission to camper, listed above, (

I accept

RELEASE OF LIABILITY: Prior to my CHILD involvement in the kids camp activities, I acknowledge that involvement of my child/children in the Event may involve risk of property damage and of personal injury, illness or even death, including but not limited to the risks arising from transportation-related activities, recreational activities, accidents in and around facilities, adverse weather conditions, and injuries and illness as a result of food-borne illness and allergic reactions.

I agree

CONSENT TO MEDICAL TREATMENT: I hereby give my consent that my CHILD may receive medical treatment that may be deemed advisable in the event of injury, accident and/or illness during this Event.

I agree

I authorize FSBC Kids Camp to use my camper's picture, testimony, and video in any promotional material (web, print or media).

I agree I decline

AUTHORITY TO SIGN: By signing below, you agree that you are the parent or legal guardian of the above named camper, ("CHILD") and have the full power and authority to enter into this Parental Consent and Release of Liability on behalf of your child. In addition, by signing below, you acknowledge that you have read and understand this document, and also represent that all information provided is accurate.

Payment Table

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

FSBC Kid's Camp 2025

Description

Please Fix the Following