Faithy's Adventure Elite Summer Camp

Please allow approximately 15 minutes to complete the application. Limit one (1) application submisson per student.

Camper Information

Camper's Full Name

Camper's School

Upcoming grade in the Fall of 2026:

Gender

Race/Ethnicity (Select all that apply):

American Indian/Alaskan Native Asian Black/African American Hispanic/Latino Native Hawaiian/Pacific Islander White/Caucasian Other Prefer not to say

Will your camper be attending summer school or a camp at another location?

Yes No I'm not sure.

Camper's T-Shirt Size

Parent/Guardian Information

Parent/Legal Guardian (1) Full Name

Parent /Legal Guardian (1) Street Address

Parent/Legal Guardian (1) Phone

Parent /Legal Guardian (2) Full Name

Parent /Legal Guardian (2) Street Address

Parent /Legal Guardian (2) Phone

Updates to Contact Information: I agree to contact the program leadership at my site if my contact information changes.

Yes No

Medical Information

In the event of a medical emergency, what is the preferred hospital for medical treatment?

Additional information:

Food Allergies? ( If none, please write none )

Allergy to bees?

Yes No

If medication is to be distributed during the program, I understand that a medication authorization form must be on file with the program leadership and it is my responsibility to make sure the leadership has the authorized medication to be administered in a timely manner.

Medication Distribution Consent:Typing your name acts as your electronic signature.

Emergency Contact Information

Emergency Contact (1) Full Name

Emergency Contact (1) Phone Number

Emergency Contact (2) Full Name

Emergency Contact (2) Phone Number

Consent Information

Please read through and provide a response for each question.

Emergency Medical Treatment: I give permission to the program staff ( licensed by the State of Michigan ) to secure emergency medical and/or surgical treatment for the above.

Yes No

Immunizations Records: My child's immunizations are up to date. The immunization record or appropriate waiver is on file with the school. My child is in good health with activity restrictions noted.

Yes No

Field Trips: I hereby give my permission for my student to attend field trips. I understand that information will be provided prior to every field trip. I agree and accept all medical responsibility in case of emergency due to accident or illness.

Yes No

Topical Application Waiver: I give permission to the staff to provide my child with insect repellant, sunscreen, and Neosporin wound cleaner when appropriate. I understand that specific product information is available upon my request from the program leadership team.

Yes No

Program Enrollment: I understand that enrollment in this program is voluntary. In order to assure that each student makes the desired progress for academic success, I understand that regular attendance is required.

Yes No

Authorization & Payment

I authorize this program to collect and use data about my child for the purpose of the program development, safety and improvement of educational outcomes. I understand that this data will be kept confidential, stored securely, and used by authorized personnel within the organization, and shared with Michigan Department of Lifelong Education, Advancement, and Potential (MiLEAP) 32n OST Grants Program and state evaluations partners. I agree that typing my first and last name below constitutes my electronic signature.

Phone

Confirmation Email

This address will receive a confirmation email

Camp Discovery Registration Fee (includes $1.75 Service Fee) $51.75

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

Monday, June 14th to Friday, August 14th

Faithy’s Adventures Summer Camp Registration

Faithy’s Adventures Summer Camp will run Monday, June 15 through Friday, August 14 at Christian Tabernacle Church, 26555 Franklin Rd., Southfield, MI 48033.

Camp Fee: $200 per week (includes daily lunch and snack)
Registration Fee: $50 non-refundable fee required to complete registration

Please complete the form below to secure your child’s spot.

This program was made possible by the 32n OST Grant Program awarded by the Michigan Department of Lifelong Education Advancement and Potential.

Faithy's Adventure Elite Summer Camp

Description

Please Fix the Following