Power Camp Registration Form

For more information please fill out this form and a team member will get back with you with more information.

Student Info
Student Name:*
Student Birthday:*
Entering Grade in Fall 2022:*
Student Phone:*
Student E-mail:*
Which week:*
T-Shirt Size (Youth T-Shirt Sizes):
Parent/Guardian Info
Parent Name:*
Parent/Guardian Address:*
Parent/Guardian Phone:*
Parent/Guardian E-mail:*
Emergency Contact Info
Emergency Contact Name:
Emergency Contact Phone:*
Insurance Info
Insurance Company:*
Policy Number:*
Insurance Company Phone:*
Medical Doctor:*
Doctor's Office Phone:*
Other Info
What sport(s) do(es) your athlete play?*
Does your athlete have any physical defect or illness that might interfere with his participation in strenuous activity?
Explain your athlete's physical defect or illness:*
Does your athlete have any severe allergies or reactions to drugs or medicines?
Explain your athlete's severe allergies or reactions to drugs:*
Does your athlete have any emotional/social disabilities that would be helpful for us to be aware of?
Explain your athlete's emotional/social disabilities:*
Does your athlete have any history of concussions?
Explain your athlete's history of concussions:*
List any medications your athlete is presently taking or any special diet or exercise restrictions. Please include all over-the-counter medications such as Tylenol, etc. (list name of drugs, dosage, etc.):*
Date of your athlete's last tetanus shot:*
Why do you want your athlete involved in with FCA Power Camp?*
Allowed In Water:*
Your athlete lives with:*
Complete Registration
Coupon Code:
Total Due:*
Week 1 Discount A Due:*
Week 1 Discount B Due:*
Week 2 Discount A Due:*
Week 2 Discount B Due:*
2 Weeks Discount A Due:*
2 Weeks Discount B Due:*
2 Weeks Total Due:*
By checking the box below, you agree that you have read, understand, and accept the terms and conditions described below in our Terms and Conditions (click button below) and you agree to be bound by these Terms and Conditions, including all terms, policies, and guidelines incorporated in the Terms of Service by reference, including, but not limited to, the Terms and Conditions of the Fellowship of Christian Athletes.
Please select:*
Which week:(1)*