Summer Day Camp 2024: Registration

Child(ren) Info:*

Parent Info*

FatherMother Last Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

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Emergency Contact Information *

First NameLast Name

Phone Number*

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Relation*

List any other concerns instructors should be aware of (e.g, medication, health related concerns):

PARENTAL CONSENT, RELEASE, AND INDEMNITY AGREEMENT

I, the undersigned, First Name* Last Name* am the parent or legal guardian of First Name* Last Name* who was born on Date* and who resides at Street Address* City* State* Zip* .

As parent or legal guardian, I affirm that I have been completely informed of all the programs and activities that Holy Resurrection Serbian Orthodox Cathedral will host from June 5 - 23, 2023 at its facilities located at 5701 North Redwood Drive, Chicago, Illinois and hereby grant unconditional permission for First Name* Last Name* to participate in those programs and activities.

I hereby voluntarily release and forever discharge Holy Resurrection Serbian Orthodox Cathedral and its officers, directors, employees, volunteers, and agents from any and all claims, demands, or causes of action, which may occur to my child or ward in the course of these programs and activities. In the event of an emergency in which I cannot be reached, I authorize the adult leaders to make medical decisions for my child or ward, and to administer first aid if deemed necessary.

I further agree to indemnify and hold harmless Holy Resurrection Serbian Orthodox Cathedral and its officers, directors, employees, volunteers, and agents from and against any and all claims arising from the participation of my child or ward in these programs and activities or as a result of injury or illness to my child or ward during such program and activities.

By signing this waiver form, I grant permission for the child named above to participate in programs and activities that Holy Resurrection Serbian Orthodox Cathedral will host from June 10 - July 12, 2024 at its facilities located at on the property of HRSOC and St. Sava Academy in Chicago, Illinois. My child or ward is physically and mentally able to participate in these activities. I acknowledge that there are certain risks involved in connection with my child's or ward's participation and have discussed them with my child or ward as necessary.

I have read this Parental Consent, Release and Indemnity Agreement and I am fully aware of its contents.

Signature*

Date*

Date

My Products

Camp Fee$150 per child per week

$150.00

	Number of Children:	Price
Week 1 (June 10-14)		$150.00
Week 2 (June 17-21)		$150.00
Week 3 (June 24-28)		$150.00
Week 4 (July 1-5)		$150.00
Week 5 (July 8-12)		$150.00

Total

$0.00

Payment Methods

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Summer Day Camp Registration

Payment Methods