Sacred Heart Summer Camp Registration Form

Summer Camp Registration- Jun 30-Jul 3, Jul 7-9, 2025
Camper Name
Last Name*
First Name*
Middle Name*
MaleFemale
Camper's Information
Shirt Size*
Address*
City*
State*
Zip*
Home Phone

Area CodePhone Number
Emergency Contact Name(if parent or guardian is not avaliable)*
Emergency Number*

Area CodePhone Number
Emergency Number #2

Area CodePhone Number
Birth Date*

MonthDayYear
Parent or Legal Guardian Information
Name*
Relation*
Cell Phone*

Area CodePhone Number
Work Phone

Area CodePhone Number
Parent /Legal Guardian 2
Relation 2
Cell Phone 2

Area CodePhone Number
Work Phone 2

Area CodePhone Number
Email Confirmation
Parents Email (camper confirmation will be sent by email)*
Camper's Email
Health Information
It is our policy to contact the parent or guardian as soon as possible in the event of a serious accident or injury.
YesNo
YesNo
All fields are required below. If nothing applies, please put "NONE" in the box. Thanks.
Any activity the camper should be restricted from?*
Any physical, mental or other condition that would require special attention or medication while at camp?*
List any allergies (ex: bees,peanuts, dairy)*
Any dietary needs that we should know about?*
List all medications, both prescribed and over the counter*
Payment Information

$150 Registration Fee Due first day of camp, 6/30 (cash or venmo)
Camper Dismissal
Camper Release (List anyone, including parents, to whom your camper can be dismissed)*
- Be certain to enter your email address correctly on the registration form to receive confirmation via email
By hitting submit and putting your initials, you agree that you are the parent or legal guardian of the above named camper, and are over the age of 18:

In case of medical emergency or general medical care, I give consent for medical teatment for the aboved named camper by authorized personnel. I understand that the above named camper will only be released to the names listed above. I certify that my child has my permission to attend camp and participate in all activites. I authorize Sacred Heart to...
Signature*

Powered by Jotform SignClear
Electronic signature, please initial*
Should be Empty:

Summer Camp Registration- Jun 30-Jul 3, Jul 7-9, 2025

Camper Name

Camper's Information

Parent or Legal Guardian Information

Email Confirmation

Health Information

Payment Information

Camper Dismissal