Little Saints Camp

Please complete one form for each child attending camp.

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 Birthday REQUIRED Please fill out this field. Please enter valid data.

Grade Entering for the 2021-2022 School Year REQUIRED PK3 PK4 K 1 Please fill out this field.

Week 1-June 14-June 18 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 2-June 21-June 25 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 3-June 28-July 2 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 4-July 6-July 9-CLOSED JULY 5 Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 5-July 12-July 16 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 6-July 19-July 23 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 7-July 26-July 30 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 8-August 2-August 6 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 9-August 9-August 13 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Best Phone Number REQUIRED Please fill out this field. Please enter valid data.

Family Email Address REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Name 1 REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Name 2 REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact and Phone Numbers REQUIRED

Please list name, relationship, phone #. Example: Mary Smith, grandmother, 555-555-5555

Please fill out this field.

Medical Information REQUIRED

Does your child suffer from any allergies, illness or other medical condition? If yes, please detail below.

Please fill out this field.

Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Policy Number REQUIRED Please fill out this field. Please enter valid data.

Preferred Hospital REQUIRED

Please note that during an emergency, emergency dispatch may not allow for a choice in hospital.

Please fill out this field. Please enter valid data.

Pick Up Information REQUIRED

Please list who can and cannot pick up your child (ren)

Please fill out this field.

In a medical emergency, I/we hereby authorize the camp/school representative to obtain or administer emergency care and to seek emergency medical assistance for our child if we cannot be reached. I/We also authorize, if circumstances require, the emergency department physician, family physician, or school physician to provide initial examination and treatment.

Medical Release REQUIRED I/We Agree Please fill out this field.

PHOTOGRAPH RELEASE

Parent/Legal Guardian of the children listed on the registration form hereby give the Archdiocese of Philadelphia, its successors and assigns and those acting with its authority, the unqualified right and permission to reproduce, copyright, publish, circulate or otherwise use any school pictures and video of my child produced by the Archdiocese of Philadelphia and Pope John Paul II RCES & Summer Programs. This authorization and release covers the use of said camp pictures and video in any published form, including but not limited to newsletters, websites, social media, and any other media of advertising publicity. I also understand that our school may be identified by name and I fully understand that this is a complete release of all claims against the Archdiocese of Philadelphia or any other person, firm or corporation by reason of any such use of such school pictures. I hereby warrant that I am free to give this permission. I also understand that Pope John Paul II RCES & Summer Programs cannot be held responsible for photographs/video recordings taken by other parents during open performances.

Photo Release REQUIRED Yes No Please fill out this field.

Account Charge REQUIRED Yes No Please fill out this field.

CAMP PARTICIPATION AGREEMENT AND RELEASE
We (I), Parent/Legal Guardian of the child(ren) listed on the registration form
give permission for the child(ren) to participate in the Summer Programs to which includes all related programs or events. In consideration for our (my) son’s/daughter’s participation and intending to be legally bound, we (I) and our (my) son/daughter agree and understand that we assume risk in full for our (my) son’s/daughter’s participation in the Summer Programs and with full knowledge of the risk inherent in such an activity, we release and hold harmless Pope John Paul II Regional Catholic Elementary School, affiliated parishes, the Archdiocese of Philadelphia, and its priests, religious, teachers, aides, employees, agents, administrators, and any official representatives, from any and all liability, damages, or claims for any and all personal injury, bodily injury, and/or property damage arising or related to our (my) son’s/daughter’s participation. We (I) and our (my) son/daughter understand and agree to abide by all rules and regulations established by Pope John Paul II Regional Catholic Elementary School pertaining to the Summer Programs and school code of conduct.

Camp Participation Agreement REQUIRED I/We Agree Please fill out this field.