Summer Camp

Camp Highlander Registration

Please fill out the form below to register your son for Camp Highlander. Registration Closes Monday June 7th.
Number of Campers Attending
($600 for one camper; $500 each for two or more campers.)
Are you a member of the St. Nicholas Guild?
Guild members receive a $100 discount per camper. Click here to learn more about the St. Nicholas Guild.
St. Nicholas Guild Discount Code
Total Cost
Camper Information
First Camper's Information
Camper's First Name
Camper's Last Name
Age
Grade Level This Coming Academic Year
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMonth-Date-Year
Shirt Size
Second Camper's Information
Second Camper's First Name
Second Camper's Last Name
Age
Grade Level This Coming Academic Year
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearMonth-Date-Year
Shirt Size
Third Camper's Information
Third Camper's First Name
Third Camper's Last Name
Age
Grade Level This Coming Academic Year
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year Month-Date-Year
Shirt Size
Parent or Guardian
Parent's or Guardian's First Name
Parent's or Guardian's Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Minor Participant Agreement & Medical Record

Your registration will not be complete until this form has been received.
Camper's Health History

Does participant currently have, or has he ever been treated for any of the following?
First Camper's Health History

Does participant currently have, or has he ever been treated for any of the following?
Abdominal/digestive problems
Fainting spells
Lung/respiratory disease
Asthma/breathing problems
Kidney disease
Muscular/skeletal condition
Behavioral/neurological disorders
Thyroid disease/sleep disorders
Bleeding disorders
Heart disease
Sickle cell disease
Ear/sinus problems
High blood pressure
Seizures
Excessive fatigue
Allergies
Immunizations: Please check yes or no if the child is up to date on recommended immunizations.
Medications: Please indicate below all medications currently being used, including items for occasional or emergency use. Email additional forms if additional space is needed. Any personal medications (prescription and/or over-the-counter), vitamins, herbs, and enzymes MUST have a doctor's order and be brought in the original bottle to the Camp Director to be administered to Participant. All medications must be original container with pharmacy label including patient name, physician name, medication name, prescription number, date prescribed, dosage.
Medication - Strength - Frequency - Approximate Date Started - Needed For
Does the Participant have any physical condition or illness which would prevent him from participating in normal rigorous activity?
Can the participant swim?
Consent for Special Dietary Needs
Second Camper's Health History

Does participant currently have, or has he ever been treated for any of the following?
Abdominal/digestive problems
Fainting spells
Lung/respiratory disease
Asthma/breathing problems
Kidney disease
Muscular/skeletal condition
Behavioral/neurological disorders
Thyroid disease/sleep disorders
Bleeding disorders
Heart disease
Sickle cell disease
Ear/sinus problems
High blood pressure
Seizures
Excessive fatigue
Allergies
Immunizations: Please check yes or no if the child is up to date on recommended immunizations.
Medications: Please indicate below all medications currently being used, including items for occasional or emergency use. Email additional forms if additional space is needed. Any personal medications (prescription and/or over-the-counter), vitamins, herbs, and enzymes MUST have a doctor's order and be brought in the original bottle to the Camp Director to be administered to Participant. All medications must be original container with pharmacy label including patient name, physician name, medication name, prescription number, date prescribed, dosage.
Medication - Strength - Frequency - Approximate Date Started - Needed For
Does the Participant have any physical condition or illness which would prevent him from participating in normal rigorous activity?
Can the participant swim?
Food service at Highlander Camp will not be able to meet special dietary needs (food allergies, vegetarian, etc.). If you have special dietary needs you must plan to meet those needs on your own.
Consent for Special Dietary Needs
Third Camper's Health History

Does participant currently have, or has he ever been treated for any of the following?
Abdominal/digestive problems
Fainting spells
Lung/respiratory disease
Asthma/breathing problems
Kidney disease
Muscular/skeletal condition
Behavioral/neurological disorders
Thyroid disease/sleep disorders
Bleeding disorders
Heart disease
Sickle cell disease
Ear/sinus problems
High blood pressure
Seizures
Excessive fatigue
Allergies
Immunizations: Please check yes or no if the child is up to date on recommended immunizations.
Medications: Please indicate below all medications currently being used, including items for occasional or emergency use. Email additional forms if additional space is needed. Any personal medications (prescription and/or over-the-counter), vitamins, herbs, and enzymes MUST have a doctor's order and be brought in the original bottle to the Camp Director to be administered to Participant. All medications must be original container with pharmacy label including patient name, physician name, medication name, prescription number, date prescribed, dosage.
Medication - Strength - Frequency - Approximate Date Started - Needed For
Does the Participant have any physical condition or illness which would prevent him from participating in normal rigorous activity?
Can the participant swim?
Consent for Special Dietary Needs
Medical Treatment Authorization

We, the parents and/or guardians of the Participant, understand that we will be notified in the case of a medical emergency involving the Participant. However, in the event that we, or either of us, cannot be reached, we authorize the calling of a doctor and the providing of necessary medical services in the event the Participant is injured or becomes ill. We authorize any one or more of the following persons to make emergency medical care decisions on behalf of the Participant, if required by law or a health care provider:
Emergency Contact Person - First Name
Emergency Contact Person - Last Name
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
We, the parents and/or guardians of Participant, understand that Highlander Camp or any of their agents, employees, or volunteers, shall not be responsible for medical expenses incurred on the basis of this authorization. We hereby agree to hold harmless, defend and indemnify Highlander Camp & Gregory the Great Academy, its parents, subsidiaries and affiliates, board members, officers, employees, agents and volunteers from all obligations, damages, losses, attorney's fees, defense costs, demands, investigations, actions, liabilities, claims, cross-actions, third-party actions, causes of action, of any kind or nature whatsoever, including the negligence or gross negligence of Highlander Camp (collectively “claims”), that may be asserted by anyone and that has any relation to the Participant. It is our express intention to defend, indemnify and hold Highlander Camp from all claims arising out of, or resulting from, or in any manner relating to the treatment, medical or otherwise, of Participant. We agree to notify Highlander Camp in the event of any health changes which would restrict the Participant’s participation in any activities. We also understand that any Highlander Camp representative reserves the right to restrict the Participant from any activity for any reason. A photocopy or facsimile of this authorization shall be as valid as the original.*
Consent
Agreement for Parental Consent; Release and Assumption of Risk; and Photograph & Video Release

Consent of a parent or legal guardian is required for a minor to attend and participate in the activities at the 2026 Highlander Camp at 135 St. Gregory's Pl, Elmhurst Twp, PA 18444 on June 14th through June 21st, 2025. I understand that I am being asked to read the consent agreement carefully. I understand that if I wish to discuss any of the terms contained in this agreement, I may contact Christopher Smith, Event Coordinator, at csmith@gregorythegreatacademy.com.
Parent/Guardian Signature for MINOR PARTICIPANT AGREEMENT, MEDICAL RECORD, Medical Treatment Authorization and AGREEMENT FOR PARENTAL CONSENT; RELEASE AND ASSUMPTION OF RISK; AND PHOTOGRAPH & VIDEO RELEASE
Gregory the Great Academy

Payment Amount

USDDescription

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Camp Highlander Registration

Camper Information

First Camper's Information

Second Camper's Information

Third Camper's Information

Parent or Guardian

Minor Participant Agreement & Medical Record

Camper's Health History

First Camper's Health History

Second Camper's Health History

Third Camper's Health History

Agreement for Parental Consent; Release and Assumption of Risk; and Photograph & Video Release

Payment Amount