Camp SOS Registration

2017 Camper Registration

Please complete the form below to register your child. You may register 2 campers on the same form as long as they have the same contact information.
Be aware that as part of the program, campers will be provided lunch and a snack, so any food allergies must be listed below. Also, several days of the camp will involve the group walking over to the Edgewood Library, Dickson Park, and Western PA School for the Deaf in addition to the regular activities scheduled throughout the week. Several other off-site activities will involve transportation provided by FPCE/Camp SOS staff members. Please make sure to provide an emergency contact number in the event that something happens requiring us to reach someone immediately. A basic first-aid kit will be on site, but anything beyond this will require permission from parent/guardian and a possible call for medical assistance.

* Indicates required field

Name of Camper *

First

Last

Age of Camper #1 *

Camper #1: Grade Entering in 2017-18 *

Name of Camper #2 *

First

Last

Age of Camper #2 *

Camper #2: Grade Entering in 2017-18 *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Parent/Guardian Phone Number *

Name of Parent/Guardian *

First

Last

Emergency Contact Name *

First

Last

Emergency Phone Number *

Please list any allergies, medical conditions, or medications the Camp SOS staff should know about *

We would like to take photos throughout the week and post them on our website/social media as well as in future promotional materials. May we have permission to photograph your child? *

Yes No

If you would like to receive updates about the program, please enter your e-mail address *

Click here before hitting submit
to download the Medical Information/Treatment Authorization Form that must be completed, signed, and turned in on registration the first day. If any medication needs to be administered to a camper by a staff member during Camp SOS programming hours (9:00AM-2:00PM), a Medication Administration Record Form must also be completed.

Submit