I, (mother/father/guardian), do hereby give my consent to the Director of the Child Care facility, or his/her representative, for said child to receive medical or surgical aid as may be deemed necessary and expedient by a duly licensed or recognized physician or surgeon in case of emergency when parent/guardian can not be reached. Consent is also given for the Director or his/her duly appointed representative to transport said child for emergency medical treatment, if the parents cannot be reached. Please sign below.(Required)

I give, or do not give the Director of the Kid's FACtory or his/her appointed representative, permission to give my child Acetaminophen. I understand that I will be notified if that medication has been administered(Required)

I give, or do not give the Director of the Kid's FACtory or his/her appointed representative, permission to use sunscreen/ suntan lotion on my child, when weather permits. I understand that school age children may apply sunscreen to themselves with supervision.This consent is in accordance with Minimum Licensing Requirements: DCCECE/ Child Care Licensing Unit: 1100.1101.17(Required)

ACKNOWLEDGMENTS

This is a statement of verification that I have been informed that child care licensing/ child maltreatment investigators and/or law enforcement may possibly interview my child for the purpose of determining licensing compliance or for investigative purposes. This is accordance with Minimum Licensing Requirements: DCCEDE/ Child Care Licensing Unit: 200.201.4

Discipline Policy(Required)

The discipline policy of the Fayetteville Athletic Club, Kids Fit Fun FACtory will be that any time a child's behavior jeopardizes the safety of him/herself, others or is acting in a disruptive manner, the child will be removed from the class or program. The Kids FACtory uses "timeout" to encourage good behavior. A child who has been given a "timeout" will be taken out of the group/class participation and must sit alone quietly under staff supervision for 1 minute for each year of age. After the 2nd offense, another timeout will be given. Following a 3rd offense, the child will be sent home for the remainder of the day. The parents and child will need to schedule a conference with the Director to discuss the issue. Continuous or more serious behavior issues may result in suspension/ pending termination from the Kid's Fit Fun FACtory program. I understand and agree to comply with the Discipline Policy.

CAMP PHOTOGRAPHY

We will be taking pictures throughout the year to capture the action and adventure of our Kids FACtory programs. I hereby grant permission to Fayetteville Athletic Club to use photographs and/or video of my child(ren) taken during FAC programs, in publications, news releases, online, and in other communications related to the Kid FACtory programs.

SELECT YES OR NO(Required)

SUMMER CAMP PAYMENT POLICY

The Registration fee, first full week of camp fees must be paid to register for your child(ren)'s first week of summer camp. Each subsequent week my be confirmed by placing a $25 non-refundable deposit on the week(s) that your camper will attend. The balance for each week that has a deposit will be billed for the balance, the Wednesday prior to the week of camp. This balance must be paid by a credit card or bank account on file with FAC. Payments must be received for your camper to attend camp. Non-payment by the required due dates will result in relinquishing the camper's space in the program. FAC Junior Membership are required for each camper to receive the Member discount for our summer camp program. Changes or cancellation requests must be received a minimum of 2 weeks prior to the start of camp and must be made in writing to the Director. FAC member discounts will be voided and additional charges will occur if the FAC Junior membership is canceled at any time during the program duration. A $25 returned payment fee will be applied to any returned payments. Fayetteville Athletic Club accepts, Visa, Master Card, Discover, American Express, bank drafts and checks. I agree to abide by the Billing policy that has been presented.

Summer Camp 2024 Registration

2024 Hog Star Summer Camp - Camper Information (ages 5-12 years)

List all other adults who are authorized to take the child from the center:

Camper Medical Information

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