EmailMe Form - FCT - Summer Camp Registration Current Students

Child's Full Legal Name *

Preferred Name *

Child's Gender *

Female

Male

Child's Date of Birth *

MM / DD / YYYY

Parent 1 Name *

First Last

Parent 1 Relationship to Child *

Parent 1 Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

If unknown, put "unknown"

Parent 1 Home Phone Number

### - ### - ####

Parent 1 Work Phone Number

### - ### - ####

Parent 1 Cell Phone Number *

### - ### - ####

Current Email Address *

Father's Name

First Last

Parent 2 Relationship to Child

Parent 2 Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

If unknown, put "unknown"

Parent 2 Home Phone Number

### - ### - ####

Parent 2 Phone Number

### - ### - ####

Parent 2 Work Phone Number

### - ### - ####

Any Special Needs of Child?

Has child had any of the following: *

Surgery

Serious Illness/Accident

Allergies

None of the above

If any of the above are checked please explain below.

Child's Swim Ability (Select One):
If your is a weak or non-swimmer, please provide your child with a
SWIM VEST on Pool Days. *

Non-Swimmer

Weak Swimmer

Moderate Swimmer

Strong Swimmer

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