Summer Camp Enrollment Form

Freedom School Summer Peace Camp Registration
CHILD INFORMATION:
Child Name*

First NameLast Name
Birth Date*

MonthDayYear
Grade*
Name of School*
Address*

Street Address

Street Address Line 2

State / Province

Postal / Zip CodeCountry
Shirt Size
S / M/ L/ XL
PARENT/GUARDIAN INFORMATION:
Parent/Guardian Name*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
Number of siblings:
Ages of siblings:
By Signing below I am giving my child permission to attend the FREEDOM SCHOOL SUMMER CAMP AND THE TRIPS PROVIDEDBYTHE FSOC New Jersey
Parent/Guardian Signature
Date

MonthDayYear
Date
PLEASE NOTE THAT ALL FEES MUST BE PAID PRIOR TO THE STARTB OF CAMP, PAYMENTS CAN BE MADE BY CHECK PAYABLE TO THE FREEDOM SCCHOOL OF CHESILHURST OR VIA ZELLE: freedomschoolofchesilhurstnj@gmail.com
MEDICAL INFORMATION
Physician Name

First NameLast Name
Phone Number

Area CodePhone Number
Medical Concerns
Food Allergies
Medical Insurance Policy
Doctor's Name & contact number
Date of Coverage
Please upload shot record & Birth Certificate

Browse Files

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Freedom School of Chesilhurst

Safe Summer Haven
SAY CHEESE!

PHOTO RELEASE
I hereby grant the Freedom School of Chesilhurst its successors, and assigns, their agents, and those by whom have been commissioned and reuse, unrestricted and unlimited license, right, permission and consent to use and reuse, copyright, print, reproduce, publish and republish for any and all commercial advertising or public purposes, displays, publications or media my name, signature, likeness and any portraits, prints or other representations of my child in which they may appear for promoting the Freedom School of Chesilhurst, NJ
Please print your name and place your signature in the box above.
Date

MonthDayYear
Date

Freedom School Summer Peace Camp Notarized Statement of Childcare

This only needs to be filled out if you are a summer caregiver only.
I _______________________________________ hereby give notice that my child ______________________________ is residing with __________________________________ from ____________________ through ____________________________________.
I give my permission for _____________________________________________________________ to allow my child to participate in the activities of the Freedom School of Chesilhurst, NJ Summer Peace Camp.
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Freedom School Summer Peace Camp Registration