Finish Line Summer Camp Registration

Finish Line Summer Camp Registration
Tuition Information

$165/week for first child

$150/week for each additional child

PERTINENT CAMP INFORMATION

Faith Landmarks Ministries

8491 Chamberlayne Road

Richmond, VA 23227

804.262.7104

Ages: Rising 1st Grade to 9th graders

Camp will operate from June 3rd to August 2nd (closed July 4 & 5)

Camp Hours: 8:30am to 4pm

Early Arrival: 7:30am to 8:30am (additional $10/day or $25/week)

Late Pick-Up: 4pm to 5pm (additional $10/day or $25/week)

Campers must wear comfortable clothing and shoes.

Also bring lunch, two snacks, and a bottled water.

(Refrigeration is not available.)
Child Information
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Grade Entering in Fall 2024*
School*
Gender*

MaleFemale
Child's T-Shirt Size:*

YOUTH SmallADULT SmallYOUTH MediumADULT MediumYOUTH LargeADULT Large
Does camper have any allergies?*
*Please put N/A if Not Applicable
Does camper have any chronic illness or medical conditions? If yes, please describe:*
*Please put N/A if Not Applicable
Please list any other information you would like to include about your camper:
Not required

Parent/Guardian Information
Parent/Guardian #1 Name*

First NameLast Name
Parent/Guardian #1 Type*
Parent/Guardian #1 Email*
example@example.com
Parent/Guardian #1 Preferred Phone Number*
Phone Type*

HomeMobileWork
Guardian #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Type
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Preferred Phone Number
Phone Type*

HomeMobileWork
Guardian #2 Address (if different from Guardian #1)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please list names of authorized pick-ups

(18 years of age and older)
First Name* Last Name*
First Name* Last Name*

Emergency Contacts
Emergency Contact #1 Name*

First NameLast Name
Emergency Contact #1 Email*
example@example.com
Emergency Contact #1 Preferred Phone Number*
Phone Type*

HomeMobileWork
Relationship to child*
Emergency Contact #2 Name

First NameLast Name
Emergency Contact #2 Email
example@example.com
Contact #2 Preferred Phone Number
Phone Type

HomeMobileWork
Relationship to child

Weeks Selection

Please sign up for the following camp sessions. Please note: there is an additional $10 per day for campers who arrive earlier than 8:30 am and an additional $10 per day for campers that stay later than 4:00 pm, maximum of $25/week. Please contact Sue Manahan when exceptions arise at 804-262-7104 ext. 264 or smanahan@faithlandmarks.org. Also, there is a Leadership Week June 19th - 23rd for Senior Campers 14-15 year of age. Senior Campers will learn leadership skills and team activities while building confidence and having opportunities of service. VBS is during week 7 and is in the morning hours, regular camp is in the afternoon. VBS WEEK IS FREE FOR ALL (WEEK 7).
Dates:*

Week 1: June 3 - June 7Week 2: June 10 - June 14Week 3: June 17 - June 21Week 4: June 24 - June 28Week 5: July 1-July 3 (no Camp July 4&5)Week 6: July 8 - July 12Week 7: July 15 - July 19 (VBS Week FREE for all campers)Week 8: July 22 - July 26Week 9: July 29 - August 2

FAITH LANDMARKS MINISTRIES
RELEASE AND HOLD HARMLESS INDEMNIFICATION AGREEMENT

I understand and agree with the following terms and conditions pertaining to the Faith Landmarks Ministries sponsored – Finish Line Summer Camp June 12, 2023 – August 11, 2023

As evidenced by my signature below, as the participant (or parent/guardian if participant is a minor), I acknowledge that I will be participating in this activity (Finish Line Summer Camp) on my own volition and at my own risk. I hereby agree to release FLM from any and all liability, damages (direct, indirect and/or special), claims, or losses that might arise out of any loss, alteration, or destruction of personal property which I may have with me during this activity. This includes but is not limited to luggage, purses, briefcases, money, and jewelry.

I (or parent/guardian if participant is a minor) agree to hold FLM harmless from any liability, damages (direct, indirect and/or special), claims, or losses that might arise as a result of injury, sickness, disease, or death suffered by me during this activity (Finish Line Summer Camp), including but not limited to any expenses incurred for medical treatment.

I (or parent/guardian if participant is a minor) further understand that I will indemnify and forever hold and save FLM harmless from any expenses related to injury to another person or property damage caused by me or connected with my conduct in any way, including, but is not limited to, attorney’s fees.

I (or parent/guardian if participant is a minor) acknowledge that FLM does not have any insurance, including, but not limited to, insurance for health, workers compensation, disability, and/or life benefits that would cover my participation in this trip. I have my own insurance coverage or will assume full responsibility for any health claim.

I will obey the rules and regulations as prepared by FLM and distributed to me as a participant, (which may be subject to change) to manage the safety and well-being of all participants involved in this activity (Finish Line Summer Camp).

Signature of Parent/Guardian (below)

Confirmation
BY ACKNOWLEDING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS ORIGNIAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGNAL MANUAL PAPER SIGNATURE.
Activity Participation and Hold Harmless Agreement*
(Parent/Guardian Signature)
Photographs, videos, etc. may be taken during this event. These could be used at later dates for website, event promotions, shown during services, etc.
Do you approve of you, or your child’s image being photographed or videotaped during this event?*

YesNo
Should be Empty:

Finish Line Summer Camp Registration

Child Information

Parent/Guardian Information

Please list names of authorized pick-ups

Emergency Contacts

Weeks Selection