Summer Session/Camp Registration Form

Summer Session Registration-Mini Camp
Student Name
Last Name *
First Name *
Middle Name *
Gender *

Male Female
Family's Information
Address *
City *
State *
Zip *
Home Phone *

Area Code Phone Number
Emergency Contact Name(if parent or guardian is not avaliable) *
Emergency Number *

Area Code Phone Number
Emergency Number #2

Area Code Phone Number
Birth Date *

Month Day Year
Year of Graduation *
Grade entering in the fall *
Class Choice
Select 1
Please select 1
Registered Week(s)/Month(s)

Week 1 ($100) Week 2 ($100) Week 3 ($100) Week 4 ($100) Week 5 ($100) Week 6 ($100) Week 7 ($100) Week 8 ($100) 1 month (July, $350) 1 month (August, $350) 2 months (July & August, $700)
Parent or Legal Guardian Information
Parent/Legal Guardian *
Relation *
Work Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
Parent /Legal Guardian 2
Relation 2
Work Phone 2

Area Code Phone Number
Cell Phone 2

Area Code Phone Number
Church Information
Church you attend
Church City
Church you are coming with (if any)
Email Confirmation
Parents Email (summer confirmation will be sent by email)
Student's Email
Other Information
How did you hear about Fellowship?
First Time Summer Session attendee? *

Yes No
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury. If the information has changed on the day of registration please see the office administrator right away. Students should not have medication dispensed during camp/Summer Session hours unless absolutely necessary. If a child is ill, they should not attend camp. If necessary, all medication must be brought in the ORGIANAL CONTAINER or you will not be allowed to leave the medication at FCS. No exceptions. All prescriptions must be in that child's name and the correct dosage.
Is camper free from infectious desease or conditions? *

Yes No
Are immunications up to date? *

Yes No
Date of last tetanus shot *
All fileds are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from? *
Any physical, mental or other condition that would require special attention or medication while at camp? *
List any past medical treatment that would be helpful for us to know. *
List any allergies (ex: bees,peanuts, dairy) *
Any dietary needs that we should know about? *
List all medications, both prescribed and over the counter, all medications will be turned into the office except rescue inhalers. Bring all medication in original containers with child's name on the container. *
Payment Information

$50 Registration Fee Due (applied towards Session fees)
The remaining balance is due 1 month prior to Summer Session. If you have any questions, please feel free to contact the school office (206) 486-5882.
If paying with a check, please send the registration fee as soon as possible. This will hold your child's spot. You can pay multiple registration fees with one check. In memo, please put the child(ren)'s name.
Camper Release
Camper Release (List anyone, including parents, to whom your camper can be released) *
- Be certain to enter your email address correctly on the registration form to receive confirmation via email within 1 week.
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18. In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named child by authorized personnel. FCS carries secondary insurance. I understand that the above named child will only be released to the names listed above and updates may be done at registration. I certify that my child has my permission to attend FCS Summer Session and participate in all activites. I authorize FCS to use my child's picture, testimony, and video in any promotional material (web,print,or media). My child may recieve any e-mails from the Summer Session.
Signature *

Clear
Electronic signature, please initial *
Should be Empty:

Summer Session Registration-Mini Camp

Student Name

Family's Information

Class Choice

Parent or Legal Guardian Information

Church Information

Email Confirmation

Other Information

Health Information

Payment Information

Camper Release