Registration for CampAbility Special Day Camp
Completing this form & submitting your deposit reserves your child's spot. Please download and complete the Child Profile Form at https://goo.gl/gXgqgA, and return ASAP to info@abilitytreefc.org. Submit your deposit ($25 per session, which goes toward the cost of the camp session) via ATFC's PayPal. Thank you!

Please download the Physician Statement at https://goo.gl/1ZAF2M, and have your child's doctor fill it out. Return it ASAP to info@abilitytreefc.org

Email address *
Name of Camper *
Your answer
Nickname
Your answer
Address (Street, Apt#, City, & Zip) *
Your answer
Primary contact in case of emergency AND relationship *
Your answer
First Choice Phone # *
Your answer
Second Choice Phone #
Your answer
Alternate contact in case of emergency AND relationship *
Your answer
First Choice Phone # *
Your answer
Second Choice Phone #
Your answer
Who is allowed to pick up your Camper, if Primary & Alternate contacts are unable (PROVIDE FULL NAME, RELATIONSHIP, AND PHONE #) You may have more than one designated. *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Sex *
Name of school Camper attends AND entering grade *
Your answer
Services Camper receives (check all that apply)
Will your Camper attend those services during the summer? (If interested, onsite therapies will be provided through Ancient City Children's Therapy.)
Camper resides with: *
Does Camper have siblings who will be attending camp with them? *
Who is the legal guardian of Camper (name AND relationship): *
Your answer
Who will have custody of Camper during time of camp? *
Father's Name, Best Contact #, and Employer *
Your answer
Mother's Name, Best Contact #, and Employer *
Your answer
Sessions Camper will attend (check all that applies) *
Required
Days Camper will attend (check all that applies) *
Required
Camp hours are 8:00AM - 3:00PM. Will extended day be needed (3:00PM - 5:00PM)?
Other comments:
Your answer
THANK YOU for completing this registration! (click 'submit' below) Someone from Ability Tree First Coast will contact you via email to confirm your camper's spot once this registration is submitted and deposit is received.
Deposit can be made through ATFC's PayPal (https://goo.gl/qFohfi).
Any further questions, you can contact us at 855-288-6735 ext. 5 or info@abilitytreefc.org.
Submit
Never submit passwords through Google Forms.
This form was created inside of Ability Tree. Report Abuse - Terms of Service - Additional Terms