Catholic Kidz Camp Registration

CATHOLIC KIDZ CAMP REGISTRATION

June 19th through June 22nd

9:00 am to Noon

At St. Bernard School
Come join the fun!

Kidz Camp is for Pre-School Students Ages 4 – 5
and Students in Grades K – 6
(Students in grades 7th through 8th may register as helpers!)

And it only costs $10 per student if paid by May 13th! After May 13th the cost goes up to $15.

Maximum cost per family is $25 (if paid by May 13th).
Please fill out one registration form for each student.

*Child’s Name:______

Nick Name:______

Age by June 1st: ______

Gender: Male _____ Female ______

Grade entering: ______

T-Shirt Size -Please Circle one: (Youth): S M L (Adult):S M L XL

Home Church (if applicable): ______

Allergies: ______

Medical Issues or Special Needs: ______

______
*Parent Name: ______

*Address: ______

*City: ______

*State:______

*Zip: ______

*Email:______

*Home Phone Number:______

Cell Phone Number:______Other Phone #______

Emergency Information:

Emergency Contact: ______

Emergency Phone: ______

Alternate Pickup Name: ______

Alternate Pickup Phone:______

General Information: ______

Medical Release:I give my permission for the Kidz Camp staff to administer basic first aid to my child (named above) in the event of an injury. I understand that the Kidz Camp staff will contact emergency services in the event of a significant injury and all expenses for such emergency services will be paid by me.

Photo Release: I hereby grant the above named church permission to copyright and use photographs/videos taken at Kidz Camp of the minor designated above in any manner or form for any purpose lawful at any time. I waive any right that I may have to inspect or approve the finished product or written copy, that may be used in conjunction therewith, or the use to which it may be applied.

Permission to Attend: I give permission for my child (named above) to attend the Kidz Camp listed above. I understand that the information I give for this registration will only be used by the camp hosting church.

______

Parent SignatureDate

Register by May 13th and save $5 per student!!!

Parents and Grandparents:
Working with the children at camp is fun and fulfilling, please consider volunteering some of your time at the Kidz Camp! You’ll be glad you did!

Yes, I’d be glad to help!
Name: ______

Phone No.______

Email: ______

I can help on these days: Mon. ____ Tues. ____ Wed. ____ Thurs. _____

(PLEASE CHECK ALL THAT APPLY)

On Thursday June 22nd at 6:00 pm, we will have a family gathering and meal to officially close our week of Tracking Mary Kidz Camp. We hope you can join us!

Thank You!

(Please complete the back of this page also.)