After School | Camp Fire

Child's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Primary Phone*

Secondary Phone

Gender*

Date of Birth*

Grade Level*

School*

Membership Status*

Ethnicity/Race*

Total # in Family*

Receive Free/Reduced Lunch at School*

Yes
No

Household Income*

Special Needs/Disabilities*

Hearing Impairment
Learning Disabled
Visual Impairment
Orthopedic
Intellectual Disability
ADD/ADHD
Autism
None

List specific activities your child should NOT participate in*

List allergies or physical/health limitations*

Physician's Name

Physician's Phone

Do you work for the government or are you involved with the military?*

No
Yes

Father or Guardian's Information

Name

First Last

Relation to Child

Father
Step-Parent
Guardian

Cell/Personal Phone

Work Phone Number

Employer

Occupation

Mother or Guardian's Information

Name*

First Last

Relation to Child*

Mother
Step-Parent
Guardian

Cell/Personal Phone*

Work Phone Number

Employer

Occupation

Emergency Contact Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Relationship to Child*

Transportation Considerations*

Please make every effort to pick your child up from the school at 6:00 pm.
If necessary, Camp Fire vans can transport children home if arrangements cannot be made to pick them up at the school at the end of the day. Take homes do not start until all other children are picked up from the vans at the school, usually by 6:15pm. Please allow extra time for this.

No, my child will be picked up at the school
Yes, my child will need to be taken to the above listed home address

Photo Permission*

Camp Fire has my permission to use photographs in which my child (or ward) appears for Camp Fire publicity.

Yes
No

PARENTAL PERMISSION AGREEMENT*

I give my permission that my child (or ward) become a member of Camp Fire North Texas . I will observe the rules of the council and I will waive any claims against Camp Fire North Texas except for claims arising from gross negligence or willful acts of the council or its agents that may arise from participation in the activities of the Camp Fire North Texas. I understand that reasonable measures will be taken to safeguard the health and safety of all participants and that I will be notified as soon as possible in case of any emergency affecting my child (my ward). In the event I cannot be reached in an emergency, I hereby authorize the calling of a physician to provide whatever emergency medical or surgical treatment is necessary. I accept responsibility for the cost of such medical treatments. My child (or ward) has my permission to attend and participate in all Camp Fire activities at Harrell Park, including swimming, skating, canoeing, and field trips outside of Harrell Park with proper staff supervision.
I understand that an information relating to my child medical limited physical activity return to his/her school will be communicated to office personnel (not van drivers) by calling 322- 5209.
Children will be released from the vans only when the driver acknowledges the parent's arrival.

Children who are not picked up in a timely manner upon their return to school, and after every effort has been made to contact an adult (using contact numbers provided to Camp Fire) will be taken to the Children's Aid Society located at 1101 30th Street. Their telephone number is 322-3141.

If your child needs to be taken home by the Camp Fire van, the van will take the children to the school first, and then children will be taken home. Please allow extra time for this.

Disrespect and/or violent behavior toward anyone at any Camp Fire event, activity or function may result in the permanent expulsion of my child (or ward) from all Camp Fire activities in the future. This includes behavior on the vans.

Yes, I have read and fully understand the parental permission agreement

Name*

Date*

Registration*

Price: $15.64

Please register only 1 child at a time on this website. For families of 3 or more, please call 940-322-5209.

Total

$0.00

*Monday*	*Tuesday*	Wednesday	*Thursday*	*Friday*
Fowler	Tower	Washington	Zundy	Burgess
Lamar	City View	Southern Hills	Franklin	Fain
Haynes	Fain	Scotland Park	Crockett	Jefferson
Sheppard	Milam	Fowler	Lamar	Washington
Scotland Park	Cunningham	Haynes		Kirby
West Foundation	Crockett			McNiel
				Barwise
				City View Jr High