Camper Application

FOCA Junior Summer Sports Tournament for Ages 10-17

Deadline is June 17th - $20 Charge if submitted after the deadline

Please fill out the registration form below

First Name: 

Last Name: 

Age:

Grade going into Fall 2007:

Male or Female:

Address Line 1:

Address Line 2:

City:

State (Abbreviation please):

Zip Code:

Phone # Primary:

Phone #2 Alternate:

Email of Parents:

Email of Youth:

Parish you attend:

Parish Priest (First and Last Name):

Diocese:

Priest's Phone #:

Transportation

Please check only one option:

1. Parent or Guradian will be bringing and picking up camper. 

2. Parent or Guardian has made arrangements for camper's transportation.

If you chose the 2nd option, please indicate here the first and last name of the person picking up the camper:

Contact Phone / Cell Phone:

Agreement

Parent or Guardian Must Complete this Section

Please indicate the first and last name of the parent or guardian that is reading this section here :

The undersigned acknowledge that during participation at this Orthodox Christian Camp Program, at the camp site and at other facilities used for supervised camp-related activities, certain risks and dangers may occur. These include, but are not limited to, loss or damage to personal property, physical or psychological damages and/or injury, not excluding fatality, due to accidents, which may occur. I also acknowledge that participants may be transported off the camp for supervised camp-related activities. In consideration, and as a part of the right to participate in this Orthodox Christian Camp Program, I have and do hereby assume all of the above risks and any other ordinary risk incidental to the nature of these activities which are not specifically foreseeable, and will hold the Orthodox Church in America, the Orthodox Christian Camp Program, and others providing service to the camp, harmless from any and all liability actions, causes of action, debts, claims, and demands of every kind and nature whatsoever, whether for bodily injury, property damage or loss, which may arise in connection with the participant’s participation in this Orthodox Camp Program.

Parent or gaurdian must initial here. By initialing here, the parent or guardian of the camper has read and does understand the above agreement:

You are now finished with phase one of the registration process. You are not completely finished with the registration process. Please print up and fill out the Health and Medical Information Form, the Camper Behavior Contract, and the Medical Dispensation Form. Send this information and $200 payment (checks can be made out to The Fellowship of Orthodox Christians in America) to: Neena A. Malinich, 4023 Gallagher Loop, Casselberry, FL 32707 .