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2021 FSDC SPORTS CAMP APPLICATION
This form takes 3-5 minutes to fill out. To complete your registration, you must include credit card information to make the payment.
YOU CAN REGISTER MULTIPLE CHILDREN ON THIS REGISTRATION FORM
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Email *
How did you hear about us? *
Parent #1 Last Name *
Parent #1 First Name *
Parent #1 Cell Phone Number *
Parent #2 Last Name (If applicable) *
Parent #2 First Name (If applicable) *
Parent #2 Cell Phone Number (If applicable) *
Home Address (House #, Street or Ave) *
Zip Code *
Home Number (If applicable) *
Emergency Contact Name #1 (Last/First Name AND Phone #) ** Other than Parent #1 or Parent #2 - Ex. Aunt, Uncle, Grandparent, Neighbor ** *
Emergency Contact Name #2 (Last/First Name AND Phone #) ** Other than Parent #1 or Parent #2 - Ex. Aunt, Uncle, Grandparent, Neighbor ** *
Camper #1 - Last Name/First Name *
Camper #1 Age (Summer 2020) & Date of Birth *
Camper #1 School & Grade *
Camper #2 - Last Name/First Name *
Camper #2 Age (Summer 2020) & Date of Birth
Camper #2 - School & Grade
Which camp do you want to register for? (Check all that apply) *
Required
Medical Insurance Company (Ex. GHI, Blue Cross/Blue Shield etc...
Medical Insurance Policy Number
Credit Card Number (We will take a $500 deposit per child to hold your spot which is completely refundable before 06/01/20) *
Credit Card Expiration Date *
Credit Card Security Code *
Credit Card Holders Zip Code *
ACKNOWLEDGEMENT: There are NO REFUNDS once payment is made. Daily absences are not reimbursed or credited. The camp holds the right to suspend or expel any camper who exhibits inappropriate behavior, WITHOUT a refund. I agree to allow Fun Station Day Camp to use any video or photography of camp day activities for promotion or other benefits. I agree to hold Fun Station, Fun Station Day Camp, Chris Mancusi or any of the employees, coaches or counselors harmless in the event of an injury or accident. Campers medical insurance will serve as primary & camp insurance will be an additional insurance in the event of an incident. I acknowledge that my child is in physical shape to withstand the sport which I am registering. I hereby release and agree to hold Fun Station Day Camp harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the camp, or that may otherwise arise in any way in connection with any services received from Fun Station Day Camp. I understand that this release discharges Fun Station Day Camp from any liability or claim that I, my heirs, or any personal representatives may have against the camp with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Fun Station Day Camp. This liability waiver and release extends to the camp together with all owners, partners, and employees. PLEASE TYPE YOUR NAME BELOW TO AGREE *
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