Friendship Circle Summer Camp 2017 Registration Form
We are so excited for Summer Camp 2017!

Camp will run everyday between 10AM and 3PM! It will take place at the Valley of the Sun Jewish Community Center on Scottsdale Road and Sweetwater from Sunday June 5th - Friday June 9th.

Fees: $75 per day or $300 for the entire week ~ Scholarships are available, inquire with Rabbi Mendy for details.

You Can view our Camp Handbook at www.fcaz.org/Handbook.

Camper Full Name
Your answer
Camper Date of Birth
MM
/
DD
/
YYYY
Home Address
Your answer
Phone number
Your answer
What school does the camper attend?
Your answer
What grade will they be in during the 2017-2018 school year?
Your answer
Parent/Guardian Name(s)
Your answer
Cell Phone #
Your answer
Email Address
Your answer
Camper Doctor Name
Your answer
Camper Doctor Phone #
Your answer
Medical Insurance Provider
Your answer
Emergency information of TWO people to be called in the event that we cannot reach either parent/guardian
Emergency Contact #1 Name, Relationship and Phone Number
Your answer
Emergency Contact #2 Name, Relationship and Phone Number
Your answer
Authorized Person for pick-up (in addition to parents and emergency contacts)?
Your answer
Does your child have any allergies and/or intolerances to food, medication or any other substances? What are the symptoms and action to be taken if any?
Your answer
Please provide information on any chronic physical problems and pertinent developmental information and any special accommodations needed. Attach additional sheets if necessary.
Your answer
Does your camper have any triggers that we should know about/avoid?
Your answer
Is there anything else behaviorally that we should keep in mind to make your campers experience the best it can be?
Your answer
What special logistics should be taken into account? (potty trained, walkers/wheelchairs needed, etc?)
Your answer
Will your camper be required to take medication during the camp day?
IF applicable, what medication and who will administer? (will require follow up phone call with a FC professional staff)
Your answer
I give permission to the Friendship Circle of Arizona and it's professional staff members to transport my camper to and from Field Trips using methods of transportation such as rented vans and school busses.
Does your child need to ride in a car seat?
Days Attending
Required
Payment Options
Camper T-Shirt Size? (included for full week registrations; otherwise $10 per tshirt)
Would you like to purchase an additional tshirt? ($10)
More information will be sent to your family once this registration form is received... such as schedules for the week, parent info packet, packing list for each day. Waivers for individual field trips based on the sessions will also be sent.
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