2024 FSM Summer Camp
Please complete the below form for each student attending FSM Summer Camp 2024.
Camp is open for students who just completed 6th-12th grade!
* First Name
* Last Name
* 2023-2024 Grade Level
Select one
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
*Adult Leader
* Address
* City
* State/Province
* Zip/Postal Code
* Parent Name
* Parent Email
* Emergency Contact: Name & Phone Number
* Gender
Female
Male
* Allergies / Anything else we need to know about you?
* Medications
* Insurance Company
* Policy #
* Ins. Address
* Ins. Phone #
* T-Shirt Size
Select one
Adult S
Adult M
Adult L
Adult XL
Adult 2XL
Release of Liability and Medical Consent
- I hereby waive, release and forever discharge anyone all claims, rights, and causes to action of whatsoever kind or nature for myself, my heirs, executors, and administrators against FBC and other sponsors, their agents, servants, officers, employees, directors, representatives, and assigns for injury or illness (including COVID or otherwise) which may directly or indirectly result from my participation in the FBC event, trip activity, or meetings and I further agree to save hold said parties harmless and agree to indemnify each of said persons against all liability for any loss, cost, injury, or damage to persons or property which may arise by virtue of the undersigned engaging in FBC events, activities, trips and meetings. I further state that my child is in proper physical condition to participate in the event. I recognize the sponsors of the event have not undertaken to provide the undersigned with any medical care, treatment or advice concerning my child’s participation in this event. By signing below, I understand the information above and the risks involved in the activity my child/student will be undertaking.
* Digital Signature of Parent for Release of Liability Form
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