Celebrate Summer - Registration

Celebrate Summer is now full. You may register your child (send no money) and they will be put on a waiting list. If we are able to open additional classes, we will contact you.

July 7-11, 2008. From 9:30 am to 3 pm.
We want Celebrate Summer to be the best week of your child's summer!
All Celebrate Summer tuition payments and authorization forms are due upon registration. Elective preferences (for 3rd-6th graders) will be available May 15 online and must be submitted by June 1st

Please complete all form fields below - thank you.

Personal Information:
Child 1 First Name  Last name   Age   Birthdate 
School    Grade as of 9/2008 
Child 2 First Name  Last name   Age   Birthdate 
School    Grade as of 9/2008 
Child 3 First Name  Last name   Age   Birthdate 
School    Grade as of 9/2008 
Home Address    City 
State    Zip 
Home Church    Home Phone 
Mother's Full Name    Work Phone     Cell/Pager 
Father's Name    Work Phone     Cell/Pager 
Relative or friend to contact in case parent is unavailable:
Full Name    Relationship     Phone 
Full Name    Relationship     Phone 
Health Information:  [ please be specific ]
Allergies
Any disease, illness or limitation we need to be aware of?  
Tetanus current?       
Doctor's Name    Phone 
Insurance Company/s     Policy Number/s 
T-Shirts:  [ included in registration fee! ]
Child 1    Child 2    Child 3 
Electives:  [applies to rising 3rd-6th grades only]
Please Note!  An Elective Selection Form will become available online starting May 15. An Elective Booklet will also be available online on May 15. Go to the Celebrate Summer page and look for the link to the booklet and the selection form. Electives are assigned according to your registration number as long as your Elective Selection Form is submitted by June 1.
Volunteer Opportunities -   Come Help us Celebrate Summer!
   I can assist with Funtastic Friday's Special Activities.
   I can attend my child's field trip.
   I can help wherever needed.
Authorization And Release Of Liability

'The undersigned represents to Fellowship Bible Church of Roswell, Inc.(herein referred to as FBC), a religious non-profit organization, that he/she is the legal guardian and natural parent or the legal guardian of the above named child; and the undersigned does hereby consent to such minor taking part in Celebrate Summer with full understanding insofar as such activity will involve TRAVELLING IN PRIVATE AND RENTAL VEHICLES AND/OR SCHOOL BUS, sports activities (including but not limited to: swimming, ball games, rocketry, archery), and mingling with other individuals, that there is always the risk of injury, illness, loss, and possible consequent expenses for medical, diagnostic and curative treatments, and incidental loss and expense, and the undersigned does for him/herself and for and on behalf of such minor assume risk of such expense, and does hereby wholly release FBC, the Bill Jackson family and any other representative from any responsibility or liability; and waives any claims or causes of action against it or its agents that might arise on account of loss, injury or expense occasioned by any sort of accident or any other circumstance involving such child, and agrees to hold harmless FBC and such agents in event any such claim should arise; and the undersigned agrees to abide by the rules and regulations, supervision and discipline set and applied by FBC and its agents, and does hereby authorize FBC or its representatives or other agents to arrange for consent to x-ray examinations, anesthetic, dental, medical or surgical diagnosis and treatment, and hold harmless FBC from any such actions or expenses. The undersigned will furnish payment or insurance for any such payment, at his or her own expense.'

I give my permission for my son/daughter to attend Celebrate Summer, and to be videotaped or photographed for future promotional purposes. I have read the above Authorization and Release of Liability and agree to its provisions.
I have read, I understand and agree to each of the disclosures, authorizations, directions and indemnifications. The typed version of my name is being accepted as my original signature pursuant to the Georgia Electronic Records and Signature Act.
I accept this Authorization And Release Of Liability 
Parent/Guardian's Name    Relationship to minor/s
Email
Choose Payment Method & Submit Registration

Please double check all your information before submitting this registration form - thank you.

The Camp Fee is $125/child  [this includes the camp t-shirt]

The full camp fee of $125 is due upon registration. If you choose not to pay online, checks must be received within 5 days to make registration official. If you find your plans change and you must withdraw from camp, a $100 refund will be given before June 1st and a $75 refund after June 1st.
Payment method: 
If you are paying online you will be redirected to our secure online payment website when you click the Submit Registration button below.
Please click once