• If not already on file: the child’s original birth certificate (for verification purposes only)
• If not already on file: a physical or well check, no older than 2 years, signed or stamped by physician (NEW ENROLLEES)
• If not already on file: immunization records, signed or stamped by physician (NEW ENROLLEES).
  • The following School Entrance Health Form can be used for your child’s health records; Part I is completed by a parent or guardian, Part II and Part III must be completed by the Medical Provider.
• Health Record Release Form If you have turned in your health records to your school they can make a copy for us upon completion of this form. Please submit to your school’s main office along with a copy of your driver’s license.

A $55.00 non-refundable registration fee (per child) and fees for the first week enrolled to attend are due at the time of sign-up. 

• Payment Methods: Check, Cash or Money Order only. Checks must be written in black or blue ink.
• FCCC does not hold payments or accept post-dated checks.

PAYMENT BOOK – not currently provided

PAYMENT ARRANGEMENT REQUEST FORM

FCCC only accepts checks, cash, or money orders.

For your taxes, our Tax ID# is 54-1590790.

For the 2020 tax year, since payment books were not available for you to track your payments, FCCC is waiving charges to print you an Annual Statement.  Complete and submit our Annual Statement Request Form and we will return your copy as requested.

Qualifying for a sliding scale tuition rate (Step 1, Step 2, or Step 3 fees) requires proof of your annual household income and completion of FCCC’s Income Verification Form. Your annual income includes all wages, child support, social security, etc. You will be charged full fee tuition until required documentation is received and verified.  The two most recent pay stubs for all household wage earners are required for proof of income.  If you have been approved for assistance through the DSS Daycare Assistance Program FCCC will need to see your verification letter from DSS.  To contact the Department of Social Services for assistance call (540) 422-8450.

If your child requires emergency medications the following forms must be on file along with the prescribed medication:

• MAT Form, 12-month
• (completed by parent, signed by doctor, valid for 12 months)
• Emergency Care Plan: Epi-pen (completed by parent, signed by doctor)
• Emergency Care Plan: Inhaler (completed by parent, signed by doctor)
• Short-term Medication Authorization Form (completed by parent, authorization not to exceed 10 days)
• Insect Repellant Authorization Form  (completed by parent, for daily insect repellant usage)

If your child has food allergies and will need an alternate snack the CACFP Special Dietary Prescription Form needs to be completed in its entirety for FCCC to remain in compliance with USDA regulations.

• CACFP Special Dietary Prescription Form

• 2020-2021 School Year Change of Care Form
• 2020-2021 School Year Change of Care Form, FCPS1 Employee

You will receive an eHandbook emailed to you after you complete the enrollment process. 

2020-2021 School Year eHandbook

Withdrawal from the program must be received, in writing, a full week prior to your child’s last date of attendance.

• Tuition is a weekly fee and is not prorated for withdrawal. If your withdrawal ends mid-week fees are due for the entire week.
• Once complete the following form can be taken to the FCCC center your child attends, e-mailed, or faxed to the Main Office at (540) 347-3518.

Withdrawal Form

• Brumfield Summer Camp
• H.M. Pearson Summer Camp
• P.B. Smith Summer Camp
• Teen Camp

• If not already on file: the child’s original birth certificate (for verification purposes only)
• If not already on file: a physical or well check, no older than 2 years, signed or stamped by physician (NEW ENROLLEES)
• If not already on file: immunization records, signed or stamped by physician (NEW ENROLLEES).
  • The following School Entrance Health Form can be used for your child’s health records; Part I is completed by a parent or guardian, Part II and Part III must be completed by the Medical Provider.
• Health Record Release Form If you have turned in your health records to your school they can make a copy for us upon completion of this form. Please submit to your school’s main office along with a copy of your driver’s license.

A $55.00 non-refundable registration fee (per child) and fees for the first week enrolled to attend are due at the time of sign-up. 

• Payment Methods: Check, Cash or Money Order only. Checks must be written in black or blue ink.
• FCCC does not hold payments or accept post-dated checks.
• 2019 Summer Camp Tuition Chart

You will receive a payment book at the time of enrollment.   The following link will allow you to print additional payment coupons.  Payment coupons must be attached to your payment. FCCC only accepts checks, cash, or money orders. Payment Coupon The following form can be used to set up a payment arrangement: Request for Payment Arrangement

• MAT Form, 12-month
  
• (completed by parent, signed by doctor, valid for 12 months)
• Emergency Care Plan: Epi-pen
  (completed by parent, signed by doctor)
• Emergency Care Plan: Inhaler
  (completed by parent, signed by doctor)
• Short-term Medication Authorization Form
  (completed by parent, authorization not to exceed 10 days)
• Insect Repellant Authorization Form 
  (completed by parent, for daily insect repellant usage)

If your child has food allergies and will need an alternate snack the USDA Special Diet Form needs to be completed in its entirety for FCCC to remain in compliance with USDA regulations.

• USDA Special Diet Form

You will receive a handbook at the time of enrollment.  Click on the following link to view the on-line version: 2019 Summer Camp Handbook

Changes or cancellations from the FCCC Summer Camp program must be received by the administrative office, in writing, before 6:30 PM, May 24, 2019. If changes or cancellations are not made by 6:30 PM, May 24, 2019 your account will be charged for the number of weeks on your Payment Agreement. If you would like to add weeks of care after May 24, e-mail, or call the main office at (540) 347-6970, as soon as possible. We need a minimum of 3 business days to process your request. All requests are subject to availability.

• Once complete, the following form can be taken to any FCCC location, e-mailed or faxed to the Main Office at (540) 347-3518.
• Parents will receive written confirmation of a withdrawal, change or cancellation.
• For additional information please refer to the Summer Camp Handbook.

Camp Cancellation Form