Preschool Summer Camp

Firm Foundation Academy Summer Camp

June 1st - June 26th | 8:00AM-4:30PM
Child's Name*

First NameLast Name
Birthday*

MonthDayYear
Date
Age
Nickname
YesNo
2T3T4TXSSML
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mom's Full Name

First NameLast Name
Mom's Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Mom's Work #
Please enter a valid phone number.Format: (000) 000-0000.
Home #
Please enter a valid phone number.Format: (000) 000-0000.
Dad's Full Name

First NameLast Name
Dad's Cell #
Please enter a valid phone number.Format: (000) 000-0000.
Dad's Work #
Please enter a valid phone number.Format: (000) 000-0000.
Home #
Please enter a valid phone number.Format: (000) 000-0000.
Allergies/Medical Conditions
Emergency Contact & Release of Child
Emergency Contact #1
Emergency Contact #1 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Emergency Contact #2
Emergency Contact #2 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
Emergency Contact #3
Emergency Contact #3 Phone
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Child
I First Name Last Name give Firm Foundations & International Praise Church of God permission to obtain emergency treatment for my child while in their care.
I certify that I have completed this form accurately and agree to notify Firm Foundations and International Praise Church of God of any changes by promptly updating this form.
Signature
Today's Date

MonthDayYear
Date
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Firm Foundation Academy Summer Camp