COM ED Youth Spring Camp Registration Form

Report
Community Education
Youth Spring Break Mini Camp
WHEN: Spring Break (March 16th – 27th)
WHERE: Community ED Facility
Cafetorium
Registration Now
WHO: 1st – 5th Grade
Time: 9:00 a.m. – 11:00 a.m.
Cost:
$100 (per session)
For more information log onto www.fusdaz.org Or please contact
Community Education, [email protected]/480-987-5385 or 480-987-5386
REGISTER ONLINE: https://payment.fusdaz.org or submit registration below to:
Community Education, P.O. Box 2850, Florence, AZ 85132
Student’s First
Name
Home Address
Gender
City, ST, Zip
Grade
Students School
Age
Emergency
Contact
Mother’s Name
Emergency
Contact #
Father’s Name
Permission to
photograph?
Mother’s Cell
How will your
child get home?
Father’s Cell
Authorized to
pick up?
Email Address
Special Care?
I give permission for my child to participate in the sports program listed. I/we understand all risks and hazards incidental
to such participation and do hereby waive, release, absolve, indemnify and hold harmless Florence Unified School District
and the school from any claim arising out of any injury to my child.
Parent Signature:_________________________________
I give permission to photograph my child during camp participation for publicity use and/or news release.
YES NO
Does your child have health conditions/concerns of which staff should be aware? If so, please explain:
PAYMENT:
Register online at https://payment.fusdaz.org
For online payment questions call (480) 987-5386. For camp related questions, contact the coach listed above.
For office use only: Item #

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