2019 9th and 10th Grade Camp Registration

Camper's Name *
Camper's Name
Please provide your camper's full legal name. Since your camper will be entering 9th or 10th grade next year, he or she will be attending 9th and 10th Grade Camp from Sunday, June 9 – Saturday, June 15.
Camper’s Date of Birth *
Camper’s Date of Birth
Camper's Mailing Address *
Camper's Mailing Address
Camper's Parent/Legal Guardian *
Camper's Parent/Legal Guardian
Please provide the full legal name of this camper's parent or legal guardian.
Parent/Legal Guardian Phone Number  *
Parent/Legal Guardian Phone Number 
If someone other than the parent/legal guardian is the camper's emergency contact, please give his or her full name and phone number here.
Does the camper have any dietary restrictions, allergies, or restrictions on activities? If so, please describe them here.
Please provide here a list of medications with instructions as to the method and dosage for administering them. Medications must be turned over to camp staff upon arrival.
Please give the name of the camper's health insurance provider.
The cost of 9th and 10th grade camp is $150. We want everyone to come to camp. No one should feel that he or she can not come to camp because he or she does not have the money. The Diocese subsidizes the operations and staffing of its camps to keep the camper fees minimal. Please select the payment option that best describes your situation. If you can contribute some of the cost of camp or do not need a scholarship, instructions for how to pay the registration fee will be included in the registration confirmation.
If you need to provide any further information that relates to the camper that has not been addressed on this form, please provide it in the area below.
Camper Behavior Expectations *
No drugs, tobacco, or anything that can be considered a weapon are to be brought to camp. Because camp is a place of spiritual community and renewal, we will ask campers to turn in all electronics, including cell phones, mp3 players, and e-readers, so they can be present at camp. We will also insist that campers refrain from inappropriate sexual or violent behavior while at camp. And, of course, campers are to be respectful of everything and everyone at camp.
Parent/Guardian Release *
By selecting the box below, you as the parent or guardian affirm: the health history for this child is correct to the best of my knowledge. This child has permission to attend camp and engage in all activities, except as noted. If I cannot be reached in an emergency, I hearby give permission to the physician selected by the Camp Director or Nurse to hospitalize, secure treatment, and to order injections, anesthesia, or surgery for my child. I further understand that completion of this registration grants permission to use photos of my child, taken at camp, for publicity purposes.