F.L.Y. HIGH Summer Camp Application 2025

F.L.Y. HIGH Summer Camp Application

Thank you for your interest in the Fly High Summer Camp! The camp will be Hosted at Africentric Early CollegeCamp Dates: June 9 - August 14, 2025 (subject to change)Please complete one application per child.
Section 1: Camper Information

Please provide basic information about your child.
Campers Name

First NameMiddle NameLast NameSuffix
Birth Date

MonthDayYear
Campers age as of June 9th, 2025
Your answer
Grade level completed (June 1st, 2025)
Your answer
Gender
Current School
Campers T-Shirt Size
Does your child have Medical Insurance? If yes, please list the Name of Insurance.
Name
Medical Insurance - Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name of the Insurance Holder

First NameLast Name
Medical Insurance - Group #:
Medical Insurance - Policy #:
Does your child have siblings attending the camp? If so, Please list sibling(s) name(s). Please Note: All siblings must have their own application This helps us connect family members attending the camp.
Campers Residential Address for the Summer

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
Format: (000) 000-0000.
Social Media: #1
List the Platform: Ex. (fb or ig) and Campers Handle Ex. @flyhighohio (fb - @flyhighohio)
Social Media: #2
List the Platform: Ex. (fb or ig) and Campers Handle Ex. @flyhighohio (ig - @flyhighohio)
Section 2: Parent/Guardian Information
Parent/Guardian Full Name

First NameLast NameSuffix
Relationship to Camper
Email Address
example@example.com
Phone Number (Primary Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Alternate)
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Comments
Section 3: Emergency Contact Information
Emergency Contact Full Name

First NameLast NameSuffix
Email Address
example@example.com
Phone Number (Primary Contact)
Please enter a valid phone number.Format: (000) 000-0000.
Are they authorized to pick-up?
Is there a second emergency contact you would like to add? If yes, Please provide the Name, Relationship, Email Address, Phone Number, Authorization Level.
If NO, Please enter NO into the field above.
Additional Comments
Section 4: Medical and Allergy Information

We take health & Safty serious. Please share any known medical conditions, allergies, or needs.
Does your child have any allergies? If yes: Please list all FOOD, OUTDOOR/ENVIRONMENTAL, or Other Allergies.
Does your child have any medical conditions we should be aware of? If yes: If yes, please explain below.
Does your child take any medications regularly? If yes: If yes, please list medication names, dosages, and whether it will be administered during camp hours.
Does your child have any behavioral conditions that we should know about? If yes: Please list all that apply.
Section 5: Authorized Pick-Up Person(s)

For your child's safety, only listed individuals who will be allowed to pick up the campers from camp.
Who is authorized to pick up your child? (List ALL names, relationships, and phone numbers.
Please list all. All authorized must have a valid ID at the time of pick-up.
Section 6: Camp Participation & Permissions

This section outlines expectations and obtained your consent for participation, media use, and emergency care.
Media Release Permission: I give permission for my child to be photographed or recorded for program highlights and promotional materials.
Signature
Field Trip & Activity Consent: I give permission for my child to be participate in all camp activities, including local field trips.
Signature
Emergency Medical Consent: In the event of an emergency and I cannot be reached, I authorize camp staff to seek appropriate medical treatment for my child.
Signature
Behavior Agreement: I understand that respectful behavior is expected. Repeated violations may result in dismissal from the program.
Signature
Additional Comments
Should be Empty:

F.L.Y. HIGH Summer Camp Application

Section 1: Camper Information

Section 2: Parent/Guardian Information

Section 3: Emergency Contact Information

Section 4: Medical and Allergy Information

Section 5: Authorized Pick-Up Person(s)

Section 6: Camp Participation & Permissions