FOLCC Summer Camp Program Registration

Address

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Does your child have any allergies? If so, please list them.


Medications:(Asthma patients only!!!) All prescriptions must be in the original bottle/package with the name of the child and dosage printed on the label. (FOLCC will not administer any other medication; medications must be taken before or after the program).

Does your child have a physical or mental disability?
Yes No


If we are unable to reach you in the case of an emergency, whom should we contact?


Name of additional person(s) authorized to pick child up:

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