Summer Camp Request Form 2023 - Foundation for Foster ChildrenFoundation for Foster Children

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Summer Camp

Summer Camp Criteria
Due to limited funding, requests for camps over $250 per week, specialty/therapeutic camps, or sleep-away/overnight camps may not be approved. Only one camp per youth during the time frame below can be approved.
Summer camps must fall between May 26th and August 9th.*
- I understand. My chosen summer camp falls between these dates.
Please register your youth for camp prior to submitting. Only complete this form once registration has been completed.
Please get in touch with the Summer Camp of your choice and register your student for the dates that you want them to participate. The Foundation doesn't host its own summer camp. You are responsible for identifying the summer camp of your choice. Explain to the camp that a third party will make the payment and that the Foundation for Foster Children will call them in the next few days to make the payment on your behalf. Once you have registered the student, you can complete this form for us to make the payment. Thank you!
Submitter Information
Submitter Name*
First Last
Submitter Phone Number*
Submitter Email*
Relation to Child*
Student Information
Student Name*
First Last
FSFN Person ID
Date of Birth*
MM slash DD slash YYYY
Gender*
- Female
- Male
- Nonbinary
- Other
If other, please specify*
Ethnicity*
- African-American
- Asian-American
- Caucasian
- Hispanic-Latino
- Multi-Ethnic
Parental Rights Terminated*
- Yes
- No
- Not Sure
Placement*
- Foster Home
- Group Home
- Relative (Not Bio Parent)
- Non-Relative Parent
- Other
Address where child resides:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County of Residence*
If other, please specify*
Grade*
School Currently Attending*
Is the case likely to close in the next two months?*
- Yes
- No
- Not Sure
Is this case OTI or ICPC?*
- OTI
- ICPC
- Neither
OTI: Out-of-Town Inquiry (Out of the state of FL)
ICPC - Interstate Compact on the Placement of Children. The agreement governs the placement of children from one state into another state. he individual or entity placing the child remains legally and financially responsible for the child following placement.
Does the child have a master trust fund?*
- Yes
- No
- Not Sure
Does the child have a mental health diagnosis?*
- Yes
- No
- Unsure
Is there a stay at home caregiver in the placement?*
- Yes
- No
Has a CMH/FSPT packet been completed? (for case management only)*
- Yes
- No
- Unknown
Caregiver Information
Caregiver Name*
First Last
Caregiver Phone*
Caregiver Email*
Case Manager/IL Specialist Information
Case Manager Name*
First Last
Case Manager Phone*
Case Manager Email*
Case Management Agency*
Case Management County*
Summer Camp Information
Name of Camp*
Camp Phone Number*
Camp Email*
Camp Website*
Camp Address (Address to mail check)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please attach Camp Registration
Max. file size: 50 MB.
Please specify the exact cost of one week of camp.*
Is there a stay-at-home caregiver in the child's placement?*
Do you have a letter, flyer and/or invoice stating cost of the camp?*
- Yes
- No
Please attach a letter, flyer, or invoice stating costs here.*
Max. file size: 50 MB.
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
Are there any field trips during this camp?*
- Yes
- No
Please provide the cost of all field trips during the one week chosen*
Who will transport child to and from camp?*
First Last
Please specify transporter relation to the youth*
Transporter's Cell Number*
Enter any additional questions, comments, or information here
Consent to Services, Photo/Media and Release of Information Form
This consent and release form grants permission to Foundation for Foster Children for the use of testimonies, photograph(s) or electronic media images. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time archived. Media/Photo/Testimonies consent forms and release will expire may 1st of 2024, unless: *Child turns 18, new consent form will be required *Change in placement for children under 18, new consent form will be required with current legal guardian signature. *Legal guardian/child/young adult choices to withdraw their consent for any reasons.
Consent to Services, Photo/Media and Release of Information*
- I do give consent
- I do not have permission to provide consent
Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.*
Consent to Services Photo/Media and Release of Information*
- By signing below, I hereby give the Foundation for Foster Children (FFC) permission to provide services, release data and use photos in marketing materials including, but not limited to, the website and print materials of FFC. I understand that I will not receive compensation for the use of this likeness in any form.
Signature*
Electronic Signature: Consent to Services, Media/Photo Consent Form and Testimonies*
- By checking this box you accept this electronic signature.
Consent for Release of Information*
- I approve the release of the confidential information provided in this referral to FFC and its funding agencies, including but not limited to, Orange County Commission for Children.
Have you completed the FFC Rights and Responsibilties Acknowledgement?*
- Yes
- No
FFC Rights and Responsibilities Acknowledgement is required for approval. Once you submit this form you will be redirected to this form to complete. Thank you!

Summer Camp Request Form 2023

Phone: 407.422.4615 | Fax:
2265 Lee Rd Suite 203, Winter Park, FL 32789
Email: info@foundationforfosterchildren.org

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Summer Camp

Summer Camp Criteria

Please register your youth for camp prior to submitting. Only complete this form once registration has been completed.

Submitter Information

Student Information

Caregiver Information

Case Manager/IL Specialist Information

Summer Camp Information

Consent to Services, Photo/Media and Release of Information Form

FFC Rights and Responsibilities Acknowledgement is required for approval. Once you submit this form you will be redirected to this form to complete. Thank you!