Camper Registration

- Faith Formation

CAMPER REGISTRATION
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- CAMPER FIRST NAME REQUIRED Please fill out this field. Please enter valid data.
- CAMPER LAST NAME REQUIRED Please fill out this field. Please enter valid data.
- CAMPER GENDER REQUIRED MALE FEMALE Please fill out this field.
- CAMPER GRADE NEXT FALL REQUIRED Please fill out this field.
- CAMPER AGE REQUIRED Please fill out this field. Please enter valid data.
- CAMPER T-SHIRT SIZE REQUIRED Please fill out this field.
- PARENT/GUARDIAN NAME REQUIRED Please fill out this field. Please enter valid data.
- RELATIONSHIP TO CAMPER REQUIRED Please fill out this field. Please enter valid data.
- PARENT/GAURDIAN EMAIL REQUIRED Please fill out this field. Please enter an email address.
- ADDRESS REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- PARENT/GUARDIAN PHONE REQUIRED Please fill out this field. Please enter valid data.
- I, hereby authorize the making of photographs, motion pictures, video tapes, recordings, or other memorializing of said event and my child’s participation therein, and the publication and duplication or other use thereof. I, hereby waive any rights to compensation or any right that I otherwise might have to limit or control such making or use
- I Agree Please select this field.
- EMERGENCY CONTACT (NOT PARENT) REQUIRED Please fill out this field. Please enter valid data.
- RELATIONSHIP TO CAMPER REQUIRED Please fill out this field. Please enter valid data.
- EMERGENCY CONTACT PHONE REQUIRED Please fill out this field. Please enter valid data.
- I, as Parent (guardian), hereby give my permission for his/her participation in the above named activity. I agree to direct my child to cooperate and conform to directions and instructions of parish, school, or diocesan personnel responsible for this activity. As a condition of my child being allowed to do so, I hereby release and discharge the Diocese of Orange, its constituent organizations, including but not limited to The Roman Catholic Bishop of Orange, a Corporation Sole, and their officers, employees and volunteers from any and all claims for personal injuries or property damage that she/he may suffer as a result of his/ her participation in the activity described above, whether or not such injuries or damage are caused by the negligence, active or passive, of any of the entities, individuals named or described above.
  
  I agree that in the event my child is injured as a result of his/her participation in the above named activities, including transportation to and from these activities, whether or not caused by the negligence, active or passive, of the parish, school, or diocesan youth activities program, or any of its agents or employees, recourse for the payment of any resulting hospital, medical, dental treatment or related costs and expenses will first be had against any accident, hospital, medical or dental insurance, or any available benefit plan of mine or my spouse. I am not aware of any medical condition of my child which would render it inappropriate for him/ her to participate in any activity.
  
  I, hereby give permission to the physician, nurse, dentist or licensed care staff selected by the supervisory personnel then present to render medical, dental or other appropriate treatment deemed necessary and appropriate by the physician, nurse, dentist or licensed care staff.
- MINOR PERMISSION, MEDICATION NOTIFICATION, AND RELEASE FORM I Agree
- MEDICAL CONDITIONS/ALLERGIES REQUIRED Please fill out this field.
- WILL YOUR CHILD BE TAKING ANY MEDICATIONS DURING CAMP HOURS? REQUIRED Please fill out this field.
- IF YES, PLEASE ELABORATE:
- IF YOU WOULD LIKE YOUR CAMPER TO BE PLACED IN A GROUP WITH A FRIEND (MUST BE SAME GRADE) PLEASE NOTE BELOW. WE CANNOT GAURANTEE BUT WE WILL DO OUR BEST
  
  IF YOU WOULD LIKE US TO KNOW ANYTHING SPECIFIC ABOUT YOUR CAMPER PLEASE ADVISE BELOW
- SPECIAL REQUEST/COMMENT
- CAMPER FEE$50.0
Total: $

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