Western Adventure Camp Registration

Ages 3-5 (must be 3 by June 1, 2017)


Step 1

Fill out the Shoreline Community College Registration form (will open in a new window).


Step 2

Fill out the below form.

Child #1's Name *
Child #1's Name
Child #1's Date of Birth *
Child #1's Date of Birth
Child #2's Name
Child #2's Name
Child #2's Date of Birth
Child #2's Date of Birth
Name of Parent or Legal Guardian #1 *
Name of Parent or Legal Guardian #1
Parent/Guardian #1 Primary Phone *
Parent/Guardian #1 Primary Phone
Name of Parent or Legal Guardian #2
Name of Parent or Legal Guardian #2
Parent/Guardian #2 Primary Phone
Parent/Guardian #2 Primary Phone
Street Address *
Street Address
Attending Caregiver Name *
Attending Caregiver Name
2nd Caregiver Name (Optional)
2nd Caregiver Name (Optional)
Attending Caregiver Phone Number *
Attending Caregiver Phone Number
Ok to receive text messages? *
Secondary Caregiver Phone Number
Secondary Caregiver Phone Number
Is the caregiver CPR certified? *
Is the caregiver First Aid certified? *
Emergency Contact #1 *
Emergency Contact #1
Emergency Contact #1 Phone *
Emergency Contact #1 Phone
Emergency Contact #2 *
Emergency Contact #2
Emergency Contact #2 Phone *
Emergency Contact #2 Phone
Out of State Contact
Out of State Contact
Out of State Contact Phone
Out of State Contact Phone
I give permission for my child(ren) to go home with the following adults:
I give permission for my child(ren) to go home with the following adults:
Phone Number
Phone Number
Phone Number
Phone Number
EMERGENCY TREATMENT RELEASE: *
In the event that I cannot be located, I hereby give my consent to to qualified BFCP staff to administer first aid, to call for emergency medical help, and/or to transport my child to a medical facility. I further consent to medical procedures to be performed for my child by a licensed physician or hospital if deemed necessary to safeguard my child's health. Any expense incurred will be accepted by me.
EMERGENCY TREATMENT RELEASE: *
NON-PRESCRIPTION MEDICATION: I permit an authorized adult to give my child non-prescription medication (such as Tylenol)
FIELD TRIP PERMISSION: *
My child has permission to go on Bothell Family Cooperative Field Trips within a 50 mile radius of the preschool. Parents will be notified of all field trips. Transportation to and from field trips is provided by and/or arranged by the parent. Carpooling is strictly optional and is set up by the parent.
PERMISSION TO PHOTOGRAPH: *
I give my permission for my child to be photographed and/or videotaped in scheduled preschool activities. Photography and videotapes would be used by the program for marketing or educational purposes only. Strict anonymity will be maintained for all photography and videos.