Camp St. Matt's: Holiday Edition

Holiday Edition Registration
**A separate form and payment must be made for each camper. **
Campers in grades Pre-K4 - 7th Grade are eligible to attend Holiday Camps. (*fully potty trained)

Holiday Camp spots are no longer available for 3 year olds / Pre-K3 students.
Camper Information
Camper's Name

First NameLast Name
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age
(* must be fully potty-trained)
Grade Level
Grade Level
Gender
What school does your child attend?
Address

Street Address

Street Address Line 2

CityState

Zip Code
Parent/Guardian Information
Name

First NameLast Name
Cell Number
Format: (000) 000-0000.
Work / Additional Number
Format: (000) 000-0000.
Email
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Does the camper have any food or other allergies?
Does the camper have any medical or behavioral issues that may affect participation in activities?
Does the camper require accommodations and/or have special needs? * Please note, SMES may not be able to meet the need of all campers.
Is there anything you want to share or want us to know about your camper?
How did you hear about Camp St. Matt's?

Other

FALL BREAK: OCTOBER 16 ONLY

-9:00 AM - 3:00 PM -lunch, snack, and on-campus learning adventures included -Pre-K4 - 7th grade (*fully potty trained)

$60.00

FALL BREAK: EXTENDED CARE OCTOBER 16 ONLY

-7:30 AM - 9:00 AM and 3:00 -5:30 PM

-Pre-K4 - 7th grade (*fully potty trained)

$5.00

FALL BREAK: OCTOBER 19 ONLY

-9:00 AM - 3:00 PM -lunch, snack, and on-campus learning adventures included -Pre-K4 - 7th grade (*fully potty trained)

$60.00

FALL BREAK: EXTENDED CARE OCTOBER 19 ONLY

-7:30 AM - 9:00 AM and 3:00 -5:30 PM

-Pre-K4 - 7th grade (*fully potty trained)

$5.00

FALL BREAK BUNDLE: OCTOBER 16 & 19

-9:00 AM - 3:00 PM (DOES NOT INCLUDE EXTENDED CARE; must add for each day)

-lunch, snack, and on-campus learning adventures included -Pre-K4 - 7th grade (*fully potty trained)

$110.00

Enter coupon

Subtotal

Tax

Total

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Saint Matthew's Episcopal School during the selected camp. In exchange for the acceptance of said child’s candidacy by Saint Matthew's Episcopal School, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Saint Matthew's Episcopal School and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Saint Matthew's Episcopal School including all faculty, employees, and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I ACKNOWLEDGE I HAVE READ AND UNDERSTAND THE BEHAVIOR POLICY. I ALSO ACKNOWLEDGE THE ABOVE STATED CONSENT AND LIABILITY STATEMENT. 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.

**REFUNDS ARE NOT AVAILABLE FOR HOLIDAY CAMPS.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature

Holiday Edition Registration