2026 Thurmont SEC Registration

2026 Thurmont SEC Registration
Camper Information
Camper's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Gender
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School Name
Grade entering in Fall 2026
Skills you would like your child to work on:
Your child's approximate reading level:
Does your child have any behavioral problems we should know about? If so please list. If none please type "none".

Parent Information
Parent's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Camper
Parent 2's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Camper
Emergency Contacts & Pick Up

If parent cannot be reached, these individuals may act on behalf of the child
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Camper
Second Emergency Contact

First NameLast Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to Camper
Please list all names and numbers of those who are authorized to pick up your camper! In this please note the primary pick-up person for our staff as well.

Acknowledgements & Permissions
I understand the program limitations outlined and agree to the qualifications and considerations for camp participation.
Will your camper need any additional support to participate fully in the program? If so, please describe the type of support.
I understand that Frederick Rescue Mission and the Summer Enrichment Camp cannot guarantee that there will be no cross-contamination or accommodations for specific dietary needs, and if my child requires a specialized diet for their safety it will be provided by me the parent daily.
I understand that there is no medical personnel onsite to administer medications, therefore staff and volunteers are not allowed to administer medications to the campers.
I give permission for my child to walk to a nearby park or event site on daily outings. I am also aware that my child will/can participate in field trips throughout the 2026 Summer Enrichment Camp.

*Some field trips will require separate waivers by the facilities which we are using
Today's Date

MonthDayYear
Date
I give permission for photos or videos of my child to be shared for the Mission's promotional use (social media, website, newsletter, etc.)
Signature
Today's Date

MonthDayYear
Date
I acknowledge that medical and mental health professionals are not present on site, and that staff and volunteers are not trained to handle medical situations or administer care. While all staff members are CPR‑certified, volunteers are not.

Camper Information