Summer Camp Registration Permission And Medical Release Form printable pdf download

St. James Catholic Church

2015 Summer Camp Registration, Permission, and Medical Release Form

This form and accompanying payment may be mailed or dropped off at the parish office or St. Zita’s. The Camp Coordination Staff requests

that this form be received at the parish office no later than May 31, 2015 in order to facilitate ease of planning and processing. However,

registrations will be accepted up to ten days prior to the start of your activity (space permitting).

Please complete a separate form for each child.

Part I: Registration and Payment

Name of Camper: _________________________________________________________Home Phone: _______________________________

Age: _________ Date of Birth: ___________________________

Last School Grade Completed: _______

Male/Female (circle one)

Parent 1 Name:_____________________________________________________ Work/Cell Phone:__________________________________

Parent 2 Name: _____________________________________________________Work/Cell Phone: __________________________________

Address:______________________________________________________ City/State/Zip: _________________________________________

E-mail Address: _______________________________________________________

T-Shirt Size (circle one): Child S / M / L / XL

Adult S / M / L / XL / XXL

Emergency Contact Name and Number: __________________________________________________________________________________

In consideration of the wholesome recreational and learning experience in which my son/daughter will participate, I, as parent or legal guardian

of my son/daughter do hereby agree to allow my son/daughter to participate in the following event(s): (Check all that apply):

____ Altar Server Camp / June 29-July 3 / Youth who have completed First

____ Financial Peace University / Tuesdays / June 9-August 4 / $95

Communion and 1

-2

year Altar Servers / $35

____ Financial Peace University / Thursdays / June 11-August 6 / $95

____ St. Lawrence Cooking Camp / June 29-July 3 / Age 8-15 / $85

____ Adult Bible Study / Mondays / June 15-July 27 / Adults / $25

____ Webster Springs Work Camp / July 5-10 / Completed 9

Grade, confirmed

____ CPR/First Aid Training Day Camp / June 8-12 / Age 13 and up / $55

and older / $25

____ Girls’ Pioneer Camp / June 15-19 / Girls Age 8-13 / $110

____ Saint Pope John Paul II Sports Camp / July 13-17 / Age 6-15 / $100

____ Boys’ Pioneer Camp / June 15-19 / Boys Age 8-13 / $110

____ Saint Sebastian Horsemanship Camp / July 13-17 / Age 13-18 / $100

____ Home Improvement Camp / June 15-19 / Age 14-18 / Adults / $100

____ Camp Chorister / July 13-17 / Age 10-College / $35

____ Adult Vacation Bible School / June 15-19 / Adults / $25

____ Ride for Life Bike Camp / July 20-24 / Age 13 and up / Adults / $150

____ Vacation Bible School / June 15-19 / Age 5-10 / $45

____ Hobbit Camp / July 20-24 / Age 10-14 / $110

____ Quo Vadis Camp / June 22-25 / Boys grade 6-9 / $100

____ Victorian Ball / July 25 / Age 8 and up / $20

____ Little Shepherd Drama Camp / June 22-26 / Age 5-6 / $45

____ St. Catherine of Bologna Art Camp / July 27-31 / Grades 7-12 / $100

____ Good Shepherd Drama Camp / June 22-26 / Age 7-14 / $100

____ St. Thomas the Apostle Young Artist Camp / July 27-31 / Age 8-13 / $90

____ Saint Luke Adult Art Camp / June 22-26 / Age 14 and older/ $100

____ Basketball Tournament / June 29-July 3 / Completed 9

Grade, confirmed

and older / $20

Total Amount Enclosed: $____________________ Method of Payment (circle one): Cash / Check / *Request Scholarship

(complete info below)

**{For those parents who wish to volunteer to help all week at a camp, we will offer a ½ price camp fee for that camp to your child(ren)}**

**(you must complete the next page for those camps you would like to volunteer for – we will notify you of your assigned duties during that camp)**

**Scholarship Request

Each camp annually has limited scholarship funds available to assist campers to attend camp(s) based on financial need. We ask that

parents requesting scholarships, both full and partial, sign up to help at the camp at which they request a scholarship or for another

camp. Just as the parents who pay for these camps must choose the camps their children can attend based on their family budget, we ask

those requesting scholarships to base their requests in the same way. We cannot grant a scholarship for every child for every camp, but

we will do our best to ensure that the scholarships are granted equally so that every child who needs assistance has the opportunity to

attend at least one or two camps of his/her choice.

_____I would like to request a scholarship and can volunteer to: (please choose from list on next page)

_____I would like to request a partial scholarship and can volunteer to: (please choose from list on next page)

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Summer Camp Registration Permission And Medical Release Form

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