FOSCI Summer Camp 2022

Name: FOSCI Summer Camp 2022
Start: 2022/06/30
End: 2022/06/30
Location: FOSCI Facility Location

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06/30/2022 All day

RSVP

Phone: 904-683-4986

Website: http://www.fosci.org

FOSCI Facility Location

Phone:904-683-4986

Website:http://www.fosci.org

Address: 2212 N. Myrtle Avenue, Jacksonville, Florida 32209

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FOSCI's Summer Camp Registration 2022

Date

Childs's Name *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

School Name

Enter the School Name of the last school attended.

Grade *

What grade is your child in?

Date of Birth (DOB) *

Age

Enter your child's age.

Allergies and Medical Conditions

Please list child's allergies or medical conditions, including medications that must be taken during Summer Camp time frames. If none, please enter N/A.

Parents/Guardians and Emergency Contact

Mother's Name *

First

Last

Mother's Phone *

Father's Name

First

Last

Father's Phone

Emergency Contact (If parent(s) are not available) *

First

Last

Emergency Contact Phone *

Liability/Waiver

Parent's Signature *

First

Last

Parent name can be typed and serves as an electronic signature.

Date *

(copy)

Parent's Signature *

First

Last

Parent name can be typed and serves as an electronic signature.

Date *

FAMILIES OF SLAIN CHILDREN, INC.

FOSCI Summer Camp 2022

FOSCI Summer Camp 2022

Parents/Guardians and Emergency Contact

Liability/Waiver

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