HQ FXBG Week 6 CAMP

Contact Details

Parent/Guardian Name*

First Last

Alternate Parent/Guardian Name*

Applicable if you have a spouse that will occasionally do pickup/drop off

First Last

Email*

Enter Email Confirm Email

Parent / Guardian Phone*

Camper Home Address*

Street Address Address Line 2 City State ZIP Code

Waiver

Camper Information

Camper Name*

First Nickname (if different from First Name) Last

Gender*

Rising Grade Level*

This is the grade level the camper will be attending Fall 2026

Camper Date of Birth*

Medical History*

Any surgeries or essential medical details we should need be aware of.

Allergies*

First Aid*

This camp is outside and sometimes little injuries do occur such as bee stings or scraped knees. This is a precaution and parents are always called when an incident occurs.

Is there anything else we should know about your camper?

Will they have siblings or friends in camp with them? Are they deadly afraid of spiders/ snakes? Do they have a favorite thing that helps them make friends quickly?

Emergency Contact

This is the individual who should be called if your camper is sick, injured, etc.

Emergency Contact Name*

First Last

Emergency Contact Phone*

Emergency Contact Relationship*

What is the Emergency Contact’s Relationship to the Camper?

Camper Pick Up

For anyone who is not listed as the Parent/Guardian or Alternate Parent/Guardian who will be picking up your camper.

Name

First Last

Phone

Relationship

What is the Relationship to the Camper?

Parent Guardian Electronic Signature*

I am the parent or legal guardian of the Volunteer/Participant. I have read this form and understand and acknowledge the risks and liability. I understand that by signing this form, I am giving up legal rights and remedies.

How did you hear about this camp?

HQ FXBG – Week 6: Rising 3rd, 4th, 5th 6th, 7th & 8th Graders | July 13 – July 17

Contact Details

Waiver

Camper Information

Emergency Contact

Camper Pick Up

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