Registration Form

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Thank you for choosing Free State Academy for Summer camps and classes!

Weekly camps begin the week of June 9th and end the week of July 28th. Camps run Monday through Friday either from 9am-12 or from 1pm-4pm. Each camper will receive one t-shirt. Camps are $125 for the week.
Camp Selections: Sewing, Traditional Homestead Skills, Soap-making & Herbal. Remedies, Food Preservation & Homestead Cooking, Gardening & Sustainability

Weekly classes begin on June 9th and are available in June or July. Course Selections: American Sign Language, Rocketry, Wags & Whiskers: Pet Care, and Cyber Careers & Professions, Study Skills & Logic, and Blacksmithing.

Families with three or more children receive the 10% multi-child discount.
Children attending three or more camps receive a 10% discount.
Only one disccount can be applied.
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Guardian Names* This field is required.
Primary Guardian
Secondary Guardian
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Primary Guardian Email * This field is required.
example@example.com
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Secondary Guardian Email
example@example.com
5
Primary Guardian Phone Number* This field is required.
Please enter a valid phone number.
6
Secondary Guardian Phone Number
Please enter a valid phone number.
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Residential Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Emergency contact name and phone number* This field is required.
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First Student's Name * This field is required.
First Name
Last Name
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Gender* This field is required.
Please Select
Please Select
Male
Female
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Student's Date of Birth* This field is required.
Date
Month
Day
Year
12
T-shirt size for Campers
Please Select
Please Select
youth small
youth medium
youth large
youth extra large
adult small
adult medium
adult large
adult extra large
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First Camper Choice Ages 6-12
Please Select
Soap Making & Herbal Remedies June 9th 1pm-4pm $125 per child, per week
Gardening June 9th 9am-12pm $125 per child, per week
Sewing Camp June 16th 9am-12pm $125 per child, per week
Traditional Homestead Skills June 23rd 9am-12pm $125 per child, per week
Food Preservation & Homestead Cooking July 7th 9am-12pm $125 per child, per week
Soap Making & Herbal Remedies July 14th 9am-12pm $125 per child, per week
Gardening & Sustainability July 21st 1pm-4pm $125 per child, per week
Sewing Camp July 28th 9am-12pm $125 per child, per week
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First Class Selection Ages 12-18
Please Select
Please Select
JUNE
American Sign Language: Introductory I Mondays & Wednesdays 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, June 9th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 16th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 23rd 8am-2pm $150 per child, per month
Rocketry - build rocket #1 Thursdays 4-5:30 $150 per child, per month
JULY
American Sign Language: Introductory II Monday & Wednesday 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, July 7th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 14th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 21st 8am-2pm $150 per child, per month
Rocketry - build rocket #2 Thursdays 4-5:30 $150 per child, per month
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Second Student's Name
First Name
Last Name
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Gender
Please Select
Please Select
Male
Female
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Student's Date of Birth
Date
Month
Day
Year
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T-shirt size for Campers
Please Select
Please Select
youth small
youth medium
youth large
youth extra large
adult small
adult medium
adult large
adult extra large
19
Second Camper Choice Ages 6-12
Please Select
Soap Making & Herbal Remedies June 9th 1pm-4pm $125 per child, per week
Gardening June 9th 9am-12pm $125 per child, per week
Sewing Camp June 16th 9am-12pm $125 per child, per week
Traditional Homestead Skills June 23rd 9am-12pm $125 per child, per week
Food Preservation & Homestead Cooking July 7th 9am-12pm $125 per child, per week
Soap Making & Herbal Remedies July 14th 9am-12pm $125 per child, per week
Gardening & Sustainability July 21st 1pm-4pm $125 per child, per week
Sewing Camp July 28th 9am-12pm $125 per child, per week
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Second Class Selection Ages 12-18
Please Select
Please Select
JUNE
American Sign Language: Introductory I Mondays & Wednesdays 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, June 9th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 16th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 23rd 8am-2pm $150 per child, per month
Rocketry - build rocket #1 Thursdays 4-5:30 $150 per child, per month
JULY
American Sign Language: Introductory II Monday & Wednesday 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, July 7th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 14th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 21st 8am-2pm $150 per child, per month
Rocketry - build rocket #2 Thursdays 4-5:30 $150 per child, per month
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Third Student's Name
First Name
Last Name
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Gender
Please Select
Please Select
Male
Female
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Student's Date of Birth
Date
Month
Day
Year
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T-shirt size for Campers
Please Select
Please Select
youth small
youth medium
youth large
youth extra large
adult small
adult medium
adult large
adult extra large
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Third Camper Choice Ages 6-12
Please Select
Soap Making & Herbal Remedies June 9th 1pm-4pm $125 per child, per week
Gardening June 9th 9am-12pm $125 per child, per week
Sewing Camp June 16th 9am-12pm $125 per child, per week
Traditional Homestead Skills June 23rd 9am-12pm $125 per child, per week
Food Preservation & Homestead Cooking July 7th 9am-12pm $125 per child, per week
Soap Making & Herbal Remedies July 14th 9am-12pm $125 per child, per week
Gardening & Sustainability July 21st 1pm-4pm $125 per child, per week
Sewing Camp July 28th 9am-12pm $125 per child, per week
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Third Class Selection Ages 12-18
Please Select
Please Select
JUNE
American Sign Language: Introductory I Mondays & Wednesdays 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, June 9th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 16th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 23rd 8am-2pm $150 per child, per month
Rocketry - build rocket #1 Thursdays 4-5:30 $150 per child, per month
JULY
American Sign Language: Introductory II Monday & Wednesday 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, July 7th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 14th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 21st 8am-2pm $150 per child, per month
Rocketry - build rocket #2 Thursdays 4-5:30 $150 per child, per month
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Fourth Student's Name
First Name
Last Name
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Gender
Please Select
Please Select
Male
Female
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Student's Date of Birth
Date
Month
Day
Year
30
T-shirt size for Campers
Please Select
Please Select
youth small
youth medium
youth large
youth extra large
adult small
adult medium
adult large
adult extra large
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Fourth Camper Choice Ages 6-12
Please Select
Soap Making & Herbal Remedies June 9th 1pm-4pm $125 per child, per week
Gardening June 9th 9am-12pm $125 per child, per week
Sewing Camp June 16th 9am-12pm $125 per child, per week
Traditional Homestead Skills June 23rd 9am-12pm $125 per child, per week
Food Preservation & Homestead Cooking July 7th 9am-12pm $125 per child, per week
Soap Making & Herbal Remedies July 14th 9am-12pm $125 per child, per week
Gardening & Sustainability July 21st 1pm-4pm $125 per child, per week
Sewing Camp July 28th 9am-12pm $125 per child, per week
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Fourth Class Selection Ages 12-18
Please Select
Please Select
JUNE
American Sign Language: Introductory I Mondays & Wednesdays 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, June 9th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 16th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 23rd 8am-2pm $150 per child, per month
Rocketry - build rocket #1 Thursdays 4-5:30 $150 per child, per month
JULY
American Sign Language: Introductory II Monday & Wednesday 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, July 7th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 14th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 21st 8am-2pm $150 per child, per month
Rocketry - build rocket #2 Thursdays 4-5:30 $150 per child, per month
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Fifth Student's Name
First Name
Last Name
34
Gender
Please Select
Please Select
Male
Female
35
Student's Date of Birth
Date
Month
Day
Year
36
T-shirt size for Campers
Please Select
Please Select
youth small
youth medium
youth large
youth extra large
adult small
adult medium
adult large
adult extra large
37
Fifth Camper Choice Ages 6-12
Please Select
Soap Making & Herbal Remedies June 9th 1pm-4pm $125 per child, per week
Gardening June 9th 9am-12pm $125 per child, per week
Sewing Camp June 16th 9am-12pm $125 per child, per week
Traditional Homestead Skills June 23rd 9am-12pm $125 per child, per week
Food Preservation & Homestead Cooking July 7th 9am-12pm $125 per child, per week
Soap Making & Herbal Remedies July 14th 9am-12pm $125 per child, per week
Gardening & Sustainability July 21st 1pm-4pm $125 per child, per week
Sewing Camp July 28th 9am-12pm $125 per child, per week
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Fifth Class Selection Ages 12-18
Please Select
Please Select
JUNE
American Sign Language: Introductory I Mondays & Wednesdays 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, June 9th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 16th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, June 23rd 8am-2pm $150 per child, per month
Rocketry - build rocket #1 Thursdays 4-5:30 $150 per child, per month
JULY
American Sign Language: Introductory II Monday & Wednesday 3-4pm $150 per child, per month
Wags & Whiskers Mondays 11am $125 per child, per month
Cyber Careers & Professions TBD $150 per child, per month
Study Skills & Logic Mondays & Wednesdays 9-10am $150 per child, per month
Blacksmithing - ONE day class Monday, July 7th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 14th 8am-2pm $150 per child, per month
Blacksmithing - ONE day class Monday, July 21st 8am-2pm $150 per child, per month
Rocketry - build rocket #2 Thursdays 4-5:30 $150 per child, per month
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How did you hear about FSA?
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Enter any information about your child(ren)'s needs and family situations so we can better understand them. (IEP, 504, Diagnosis, Accommodations, Personality, Behavior, Family Dynamics, Authority, etc)* This field is required.
41
Please explain any medical conditions in detail. Depending on the condition, FSA may require additional information and/or documentation. What medications will be provided for FSA to have on hand for your child? (epi pen, pain medication, allergy, etc.) * This field is required.
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Medical Release

I give permission to Free State Academy to attend to medical situations for my child/ren. My child is in good physical condition, except for listed restrictions or allergies listed above.

Should any illness or accident occur, I will not hold liable FSA adminstrators, volunteers, teaching staff or board members for medical aid rendered if any and I will fully reimburse medical or other expenses incurred in the care of my child/ren.

Free State Academy will with its best effort contact the responsible listed parent/guardian or emergency contacts. FSA will only carry out medical responsibilities if a parent/guardian or emergency contact cannot be reached in ample time.

My child/ren may receive first aid and medical attention by a duly licensed physician. My child/ren may be admitted to a hospital in case of emergency.
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Signature confirming Medical Release* This field is required.
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Personal Injury and Liability Waiver

I understand, by submitting this Release and Waiver of Liability to Free State Academy, also known as “FSA,” that our family is participating in activities at our own risk, and therefore release and forever discharge Free State Academy, the leadership individuals, and volunteers from any injury that I or my child/ren may suffer as a direct result of our participation in FSA. I knowingly and voluntarily enter into this agreement and hereby waive any and all rights, claims or causes of action of any kind arising out of my participation in FSA. I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against FSA for injury or property damage.
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Signature confirming Personal Injury and Liability Waiver* This field is required.
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Personal Responsibility For Property Damage
In the event that any property damage occurs to the belongings of our current building, a fellow student, volunteer, or staff member, as a result of my or my child/ren’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.
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Signature confirming Personal Responsibility For Property Damage* This field is required.
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48
Damage/Loss Waiver
Free State Academy is not responsible for the damage or loss of personal items belonging to students, parents staff, or volunteers.
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Signature confirming Damage/Loss Waiver* This field is required.
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50
Photo Release* This field is required.
Please Select
Please Select
I hereby grant permission to Free State Academy to use photographs and/or video of my child/ren taken in publications, news releases, online, and in other communications related to the mission of Free State Academy.
I would prefer my child/ren’s photographs and/or videos not be taken nor used by Free State Academy. I do NOT grant permission for any communications or publications related to Free State Academy
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FREE STATE ACADEMY STATEMENT OF FAITH

We believe The Holy Bible is the very Word of God in its entirety and is our only authority in matters of faith and practice.
• In the one and only God, our creator of the universe, who is eternally existing in the persons
of the Father, the Son, and the Holy Spirit.
• Jesus Christ was conceived by the Holy Spirit, born of the virgin Mary, crucified for our sins, and raised from the dead in eternal victory.
• Faith alone in Jesus Christ, the only Son of God, is the only way to eternal life.
• The Holy Spirit is a personal Being who convicts the world of sin and who regenerates, indwells, empowers, guides, and seals believers eternally for God.
• Heaven is the abode of God and the place of eternal joy for the saved, and that Hell is the
place of eternal punishment of separation from God for the lost.
• Marriage is God’s sacred gift and is to be between one man and one woman.
• Gender is God’s sacred design and is to be determined at conception, unchangeable by man.
• Human life begins at conception and is protected from conception to natural death.

I affirm that I have read, understood, and agree to respect FSA's Statement of Faith in my attitude, words, and conduct while I am affiliated with FSA.
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Signature confirming FREE STATE ACADEMY STATEMENT OF FAITH* This field is required.
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53
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I agree to the tuition and payment agreement set forth above. I understand that all tuition must be paid as stated above. I understand the refund policy as stated above. * This field is required.
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This document shall remain in effect June 2, 2025 through August 29, 2025.

I agree to abide by the Statement of Faith regardless personal beliefs. All members of my family agree to not promote an agenda contrary to the Statement of Faith.

If my behavior or conversations are contrary and interfere with the mission of FSA, I will be asked to meet with the administration and my enrollment can be terminated at any time for any reason. This release supercedes any and all previous oral or written promises or other agreements.
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Signature confirming all information and documents submitted are true and accurate.* This field is required.
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Comments
58
Date Document Signed* This field is required.
Date
Month
Day
Year
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