McFatter Summer Institue Registration Page 2025

GRADES 5-9
AUTO CAMP GRADES 9-12 ONLY

Summer Summer Camp 2025 Registration Forms

McFatter Summer Institute Camp 2025 REGISTRATION PACKET

MEDIA RELEASE FORM - STUDENT EMERGENCY CONTACT FORM - CAMP REGISTRATION PACKET

Step 1 of 2 - MEDIA RELEASE FORM

Do you permit your student to be photographed, videotaped, and/or interviewed for school publications (e.g., yearbooks and school newspapers), school and District communication tools (e.g., websites and social media), BECON-TV, and school events and activities. Note: To facilitate school publications, the District may disclose information to approved vendors, such as student’s name, student’s home address, student/parent phone number, grade level, teacher names and classroom numbers. For sporting events, athletic team member positions and jersey numbers may be disclosed.(Required)

Student Name(Required)

First Last

Student Signature(Required)

Parent Name(Required)

First Last

Parent Signature(Required)

Student Name(Required)

First Last

Address(Required)

Street Address City State ZIP Code

Date of Birth(Required)

MM slash DD slash YYYY

Is there a court order on file that prevents a parent from having contact with the student?(Required)

Preferred Name(s)/Nickname(s):

Registering Parent Name(Required)

First Last

Address ( If Different From Student )

Street Address City State ZIP Code

Home Phone(Required)

Work Phone

Parent Email(Required)

Other Parent Name

First Last

Address ( If Different From Student )

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Other Parent Email

Please list the names of persons to whom we may release your child or whom we may contact if we cannot reach you. NO STUDENT WILL BE RELEASED TO ANYONE OTHER THAN THE PERSONS LISTED BELOW. In selecting someone to whom you authorize the release of your child, consider whether this person is prepared to handle any special medical needs required by your child. I/We hereby authorize contact with, release of emergency related information, or release of the student to the following persons in the event of illness, evacuation, or other emergency that may occur while the student is in school.

First Last

Relationship to Student

Phone

I declare that the information on this form is true and correct. I will notify the school office immediately of any changes:(Required)

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Indicate which services you give consent to and would like your child to receive at school with an "x" in the appropriate check box.(Required)

Care and treatment for illness and injury

Scoliosis screening

Vision screening

Growth and development screening (body mass index)

Hearing screening

I consent to my child receiving all school health services indicated above. I understand if consent is granted, SBBC will disclose my child's education records (including medical information) to nursing vendors who provide treatment to my child.(Required)

Is your child currently diagnosed and followed by a healthcare provider for any of the following?

Asthma (currently uses daily or emergency medication)

Seizure/Epilepsy (no including febrile seizures)

Diabetes

Anaphylaxis (Life threatening allergic reaction requiring emergency medication)

Recent illness/hospitalization/surgery (describe)

Other (Describe Below)

Describe OTHER medical conditions

Does your child require medication while at school?(Required)

Does your child wear glasses/contacts?(Required)

Does your child wear hearing aid(s)?(Required)

I hereby authorize for my child's medical information, parental contact information, and other health information (collected from health services provided at school, including information stored electronically) to be shared with emergency personnel and health department officials to address conditions of public health importance, including information to meet and to prepare for potential or confirmed health conditions. For students receiving health services from school or District staff and/or contracted partners, I also authorize the District to share my child's identifiable health information and related demographics with the Florida Department of Health to conduct monitoring to assure program compliance by the District and schools, and assess the delivery of services. Medical and other information will be disclosed without consent from the parent/eligible student in case of health emergencies, as permissible by the Family Educational Rights and Privacy Act (FERPA). The school will call for emergency medical care as deemed necessary. Emergency transportation to a health care facility, as determined by paramedics, will be authorized.(Required)

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Regular Dismissal Procedures: On a typical day, how will your child leave school?(Required)

Ride in a car

Walk or bike home

Emergency Dismissal Procedures: In the event of a severe storm or other unscheduled emergency your child is instructed to:(Required)

Ride in a car

Walk or bike home

Student T-Shirt Size

SMALL

MEDIUM

LARGE

CAPTCHA

Comments

This field is for validation purposes and should be left unchanged.

Camp Information

Where:

McFatter Technical College
6500 Nova Dr, Davie, FL 33317

McFatter Summer Institue Registration Page 2025

GRADES 5-9AUTO CAMP *GRADES 9-12 ONLY*

Summer Summer Camp 2025 Registration Forms

McFatter Summer Institute Camp 2025 REGISTRATION PACKET

Section Break

Section Break

Camp Information

Where:

GRADES 5-9
AUTO CAMP GRADES 9-12 ONLY