ABC Care Summer Camp Registration 2020

ABC Care Camp FFFT Friend Registration

Summer 2021
Camper's Information
Child's Name *
Birth Date *

Month Day Year
Date
Gender *

Male Female
Address *

Street Address

Street Address Line 2

City State

Zip Code
Grade entering in Fall (2021/22) *
School Child Attends *
If other, Please tell us which school your child attends:
T-Shirt Size *
Are you a School Year 2020-2021 ABC Care Family? *
If yes, please indicate ABC Center your child attends:
Did your child attend camp last year? *

Yes No
Name of Sibling(s) *Please note, you MUST complete a separate registration for each child.

Choose Your Camp
Which Camp will your child be leaving for the FFFT from? *

DeerPark Adventure Camp Eldersburg Adventure Camp at Piney Run Park
Which day(s) will your child be attending Fierce Fabulous Fridays? (*MUST be 4th grade & up) *Please note there is limited availability for these trips. You will be notified in a separate billing email if your child is able to attend based on availability.

Week 3, July 9, Adventure Park USA Week 4, July 16, Red Zone Week 5, July 23, Hickory Falls Week 6, July 30, Climb Zone
Which camper invited you/are you coming with? *

YOUTH CAMP HEALTH HISTORY
Child's Name *

First Name Last Name
Child's Current Address *

Street Address

Street Address Line 2

City State

Zip Code
EMERGENCY CONTACT INFORMATION:
Emergency Contact: (Parent or Legal Guardian) *

First Name Last Name
Primary Phone Number *
Emergency Contact: (Other than Parent Above) *

First Name Last Name
Primary Phone Number *
Primary Care Physician (or other provider of medical care): *

First Name Last Name
Primary Care Physician Phone Number *
HEALTH INFORMATION:
Are there any health problems including physical, psychiatric, or behavioral problems of which we need to be aware? *

No Yes
If yes, please explain, otherwise mark N/A: *
Are there any medications, dietary restrictions, allergies, or special needs that we need to be aware of to ensure that your child's camp experience is positive? *

No Yes
If yes, please explain, otherwise mark N/A: *
IMMUNIZATION INFORMATION:
For campers who currently reside within the United States, a United States territory, or the District of Columbia: Does the camper have any immunization exemptions because of a parental or guardian objection or medical contraindication? *

No Yes
If yes, LIST, otherwise mark N/A: *
For campers who reside outside the United States, a United States territory, or the District of Columbia: Attach record of vaccination or immunity on Department form MDH-896

Will your child need to have medication administered while at camp? *

Yes No
**If your child will be needing to take medication while at camp, you will need to print the Medication Administration Authorization Form and/or the Asthma Action Plan and Administration Form, fill it out completely and get it back to us a minimum of 2 weeks prior to camp.
Medication Administration Authorization Form
**If your child uses asthma medication, please print this form, fill it out and return it to us no later than two weeks prior to the beginning of camp. See attached.
Asthma Action Plan & Medication Administration Authorization Form

SUMMER CAMP POLICY MANUAL ACKNOWLEDGEMENT FORM
2021 Summer Camp Policy Manual
I have read the ABC Care, Inc. Summer Camp Policy Manual and agree to abide by the requirements and policies as set forth by ABC Care, Inc. Please sign below. (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

SUNSCREEN PERMISSION
Child's Name *

First Name Last Name
It is the policy of ABC Care, Inc. that all children need sunscreen for their protection from the sun's harmful rays.
1. Parents need to apply sunscreen to their child(ren) before arriving at camp.
2. Parents need to supply sunscreen for their child(ren). Sunscreen supplied should be easily used by camper with little assistance. Campers should be able to apply their own sunscreen throughout the day.
3. Staff will supervise the application of sunscreen throughout the day and record the usage. Reapplication of the sunscreen should be according to the directions written on the container.
4. ABC Care staff may assist in the application of sunscreen on campers if necessary. Campers are not allowed to assist other campers in applying sunscreen .
SUNSCREEN NAME *
SPF *
Should my child need sunscreen in the event it ran out or it was forgotten, I give ABC Care, Inc. permission to apply camp generic sunscreen to my child. *

No Yes
Parent's Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

TRANSPORTATION AUTHORIZATION
I give ABC Care, Inc. permission to transport my child, listed below, by certified school bus service and/or ABC Care, Inc. van to and from all field trips, and between all ABC Care, Inc. summer camps.

Your signature on this blanket permission slip allows your child to attend scheduled field trips and/or ABC Care, Inc. summer camp locations for the weeks registered.

In case of emergency such as a natural disaster or national emergency, your signature on this blanket permission slip allows your child/ren to be transported by a Maryland certified bus company or ABC Care, Inc. staffer vehicle to the nearest disaster relief shelter. ABC Care, Inc. will notify parents/guardians of children’s emergency location via telephone call. The emergency telephone number (s) we use to contact parents/guardians are listed on the child’s emergency form.

I understand that all necessary precautions will be taken by ABC Care, Inc. for the safety of my child.

Reminder: Children are required to wear their camp T-shirt on field trip days. Also, ensure your child has a disposable lunch in an insulated bag with two box drinks and that he/she wears appropriate clothing as well as appropriate shoes. Thank you.
Child's Name *

First Name Last Name
Parent Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

PUBLICITY/PHOTOGRAPHY/VIDEO RECORDING RELEASE
From time to time our program may involve photographing, video recording, interviewing by an outside source, and other publicity pictures of the children in our program.

It is required by our licensing agent, Maryland Department of Health and Mental Hygiene, that parents/guardians grant permission for this type of publicity.
My child may be photographed, video recorded, or interviewed for: *

Yes No
Child's Name *

First Name Last Name
Parent's Signature: (hold down left pointer button on mouse to sign) *

Clear
Date *

Month Day Year
Date

PAYMENT INFORMATION
Once you sign this agreement, you will be sent an email within 1 week with instructions on how to log in or create an account in SmartCare, our billing program. You must fill out your billing information and pay your balance within 3 days of receiving the email or your registration will be cancelled. This can be paid either in SmartCare or by mailing or dropping off a check to our main office, or to one of our 11 center Site Directors. If you have any questions or concerns, you can contact our main office at 410-751-3700.
By signing this registration agreement on behalf of my child, I acknowledge I am financially responsible for the weeks indicated on the registration form. In case of voluntary withdrawal, absenteeism, deduction of weeks or if my child is removed from camps, I understand there will be no refund of camp fees or credit applied to my account. I agree to complete any additional paperwork (medical forms) and submit two weeks prior to start date of the camp week. I have read or will read the 2021 Summer Camp Parent Manual in its entirety and will abide by the requirements and policies as stated.
Signature: (hold down left pointer button on mouse to sign) *
Date Signed *

Month Day Year
Should be Empty:

ABC Care Camp FFFT Friend Registration

Camper's Information

Choose Your Camp

YOUTH CAMP HEALTH HISTORY

SUMMER CAMP POLICY MANUAL ACKNOWLEDGEMENT FORM

SUNSCREEN PERMISSION

TRANSPORTATION AUTHORIZATION

PUBLICITY/PHOTOGRAPHY/VIDEO RECORDING RELEASE

PAYMENT INFORMATION