Tutus Tuus 2025 Registration Form

Tutus Tuus 2025 Registration Form

Saint Alphonsus, Mount Pleasant, Iowa
Entering Grades 1-6 in the Fall::: Monday July 21- Friday July 25, 9am-3pm

Entering Grades Grades 7-12 in the Fall::: Sunday July 20- Thursday July 24, 6:30-8:45pm

Tutus Tuus is a totally Catholic summer program for the youth in our community. There is a day program available for children entering grades 1-6 in Fall 2025 and an evening program for youth entering grades 7-12 in Fall 2025. Please fill out a registration form for each child.
Which Camp?*

Day for those entering grades 1-6 in the Fall 2025Evening for those entering grades 7-12 in the Fall 2025
Camper's Information

Personal & Health & Contact
Name*

First NameLast Name
Birth Date*

MonthDayYear
Age (at time of camp)*
Grade (entering this fall)*
T-shirt Size:*

Youth SmallAdult SmaillYouth MediumAdult MediumYouth LargeAdult LargeOther
List Any Allergies and Dietary Restrictions
Medications & Frequency
Name of Family Physician
Phone Number of Family Physician

Area CodePhone Number
Insurance Company
Insurance Policy Number
Parent / Guardian Information

(All correspondence will be sent to this person)
Name*

First NameLast Name
Email*
example@example.com
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship with the Camper*
Emergency Contacts and Authorized Pick Up Persons*
Medical Authorization I understand that the Diocese of Davenport and Totus Tuus assume no responsibility for accidents which may occur in association with diocesan events and activities. I agree to use my/our personal insurance to cover any such incidents. I understand that, in the event medical intervention is needed, every attempt will be made to contact the persons listed above. In the event those individuals cannot be reached, I/We hereby give permission to the physician or any other qualified medical staff selected by the event leader to hospitalize, secure medical treatment, and/or order injection, anesthesia, or surgery for Participant as deemed necessary.*

YES, I agreeNO, I do not agree
Permission for Other Medical Matters: YES, in the event it comes to the attention of the Diocesan and/or parish chaperones that my child complains of illness, I grant permission for non-prescription medication (such as Tylenol, lozenges, etc.) to be given to Participant.*

YES, I agreeNO, I do not agree
Release of Liability for Youth and Adults:I understand all reasonable safety precautions will be taken at all times by the Diocese of Davenport and Totus Tuus and its employees and agents during the events and activities. I understand the possibility of unforeseen hazards and know the inherent possibility of risk. I agree to indemnify and hold harmless the Diocese and Totus Tuus, its leaders, employees and volunteer staff from any and all claims arising from or in connection with attending this event.*

YES, I agreeNO I do not agree
Code of Behavior for Youth and Adults: I agree to abide by and/or instruct my child to abide by all rules and regulations as outlined by the aforementioned chaperones/ representatives. I agree that if I/Participant fail(s) to abide in any way by the rules, that I/Participant can be dismissed from the event and sent home immediately at my/Participant’s expense with no right of reimbursement or refund for any amount in connection therewith from the Diocese of Davenport or its chaperones/representatives.*

YES, I agreeNO, I do not agree
Photo Release: YES, I hereby authorize St. Alphonsus, the Diocese of Davenport and Totus Tuus and its agents to utilize photographic and/or video images of me or my child by St. Alphonsus parish and the Diocese of Davenport. In giving my consent, I hereby indemnify and hold harmless St. Alphonsus parish, the Diocese of Davenport and Totus Tuus and its agents from any and all responsibility of liability. I understand that I will receive no compensation should any photograph and/or video of me or my child be used.*

YES, I agreeNO, I do not agree
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.*

Clear
How can we help?*

Adult would like to volunteer with day programTeen would like to volunteer to help with day programAdult would like to volunteer with evening programDonate money to pay for supplies/food (you can do this by marking an envelope as a Totus Tuus donation and putting it into the collection basket at Mass)Provide housing for some or all of the team. Male and female team members are not housed together.Adult or Teen would like to be part of the Summer Planning Team that will help prepare for Tutus Tuus Week.We will not be helping this summerOther
Should be Empty:

Tutus Tuus 2025 Registration Form

Camper's Information

Parent / Guardian Information