Contact Us

summerdirector@fpcconway.org

(501) 472-3604

We are delighted to have you here with us! To ensure that we provide the best care and tailored experience for your camper, please take a moment to fill out the form below.

Your input will help us understand your camper's needs, interests, and any specific requirements.

If you have any questions or need assistance, feel free to reach out to our staff. We appreciate your cooperation in providing us with the necessary information to make your camper's experience

enjoyable and fulfilling.

Click here to read the FPC SDC handbook. You can also download your own copy from this link.

Do you acknowledge that you will read the parent handbook prior to your child's first day of day school and adhere to its guidelines? *

Yes

No

What Day and Time is your kid registered for.

Do you acknowledge that tuition and other fees will be collected on the first day of each month and understand that as long as your child is enrolled, whether in attendance or not, tuition is due with a 30-day withdrawal notice? Additionally, are you aware that any account with an outstanding balance as of the 10th of each month will be charged a $10 late fee? *

Yes

No

Child's Information

First Name *

Last Name *

Phone *

Email *

Date of birth *

Child's Age *

Gender *

Please upload a photo of your child *

Please upload an image of your child we can reference for safety purposes.

Permissions

I hereby grant permission for my child's photo to be used in social media, newsletters, blogs, and any other related platforms. *

Yes, I grant permission for my child photo to be used

No. I do not want my childs photo used on any social platform.

I hereby grant permission to release my child's information (Parent Name, address, phone number, and email address) to other parents within the classroom for the purpose of creating a parent directory. *

Yes, You may use my information in the parent Directory

No, Do not share my information with other parents.

Child's Primary Residential Address

Address *

City *

State *

Postal code *

Health and Wellness

Allergies

Does your child have any allergies? *

Yes

No

If yes, please let us know about any allergies we need to be aware of.

Does your child have an EpiPen? *

Yes

No

Does your child have any dietary restrictions? *

Yes

No

If Yes, Please explain restrictions

Do we have permission to apply sunscreen to your child?

Yes

No, Do not use sunscreen on my child.

Do we have permssion to administer acetaminophen (Tylenol) to children in our facility according to the recommended dosage and guidelines.

Yes

No, Do not give my child medications

Medical History

Does your child have any medication prescribed for long-term use? *

Yes

No

Has your child experienced any previous serious illnesses or injuries? *

Yes

No

Please provide a list of medications and their respective uses for your child.

Has your child been hospitalized in the last 12 months? *

Yes

No

If Yes, Please provide an explanation for the reason your child was hospitalized.

Please Note: if you child has any listed allergies, an allergy plan must be completed. These plans can be obtained from your childs teacher at orientation.

Treatment & Transport Authorization

In the event of an emergency, I give consent for the staff to administer any necessary first aid care and to transport my child to the nearest hospital if required, as determined by first responders in the event of a 911 emergency call. *

Yes, You may treat and tranport as needed.

No, Do not treat or transport my child in any instance.

In the event of an emergency where emegency contacts are not reachable, the listed physician or the next available physician, along with the local hospital, are hereby authorized to provide any necessary emergency care for my child. Our organization reserves the right to call 911 in any emergency situation. *

Yes, I understand

Primary Physician Contact Information

Primary Care Physician *

Physician Office *

Physician Office Address *

Physician Phone Number: *

Preferred Hospital *

Dentist Information

Dentist Office *

Dentist Office Address *

Dentist Office Phone *

Emergency contacts are individuals other than the parent or guardian who can be contacted in the event of an emergency and possess knowledge of the child's medical information. These contacts do not necessarily have to be local. It is a requirement by the Department of Human Services (DHS) to have a minimum of two emergency contacts.

Emergency Contact 1

1. Emergency Contact Name *

1. Emergency Contact Relationship *

1. Emergency Contact Phone: *

1. Emergency Contact Address *

Emergency Contact 2

2. Emergency Contact Name *

2. Emergency Contact Relationship *

2. Emergency Contact Phone *

2. Emergency Contact Adress *

Parent/Guardian Information

Mother/Guardian Name *

Mother/Guardian Phone *

Occupation/Workplace

#1. Work Hours

Work Phone Number

Business Address

Email Address

Text

Father/Guardian Name *

Father or Guardian Phone *

Occupation/Workplace

Work Hours

#2 Work Phone

#2 Business Address

#2. Email Address *

Parents are ( Check all that apply) *

Divorced

Widow

Living Together

Separated

Text

Do you approve any additional person's to pick up your child? *

Yes

No

Approved Guardian Pickup - Please state Full Name and Relationship and Phone Number

Please provide images of the primary caregivers & authorized pickups. These images will be used as a safety reference for checkouts and pickup times.

I consent to receive SMS notifications, alerts, and occasional marketing communications from First Presbyterian Summer Day Camp. Message frequency varies. Message & data rates may apply. Reply HELP for help, or STOP to unsubscribe at any time.

Privacy Policy & Terms and Conditions

summerdirector@fpcconway.org

(501) 472-3604

Welcome to FPC Summer Day Camp!

Camper Registration

We are delighted to have you here with us! To ensure that we provide the best care and tailored experience for your camper, please take a moment to fill out the form below.

Your input will help us understand your camper's needs, interests, and any specific requirements.