CAMP MARIASTELLAStandard

Registration--Summer Camp, 2016

Business Office: 4316 Lanai Road, Encino, CA 91436 Phone: 818.285.1555 Fax: 818.285.1556

E-mail: Web site:

This form with $50 deposit must be received by the Camp office to confirm registration.

Please print all information:

Camper’s name______/______Shirt: child size _____ or adult size:______

Last First

Age when at camp______/______Date of Birth:______/______/______

years months month day year

Address:______Home phone: (____)______

______e-mail Parent:______

CityZip

Custodial Parent/Guardian:______Bus. Phone:______Cell Phone:______

Occupation______Relationship to Camper______

Home Address: (if different)______

E-mail address: ______

2nd Custodial Parent/Guardian:______Bus. Phone:______Cell Phone:______

Occupation______Relationship to Camper______

Home Address: (if different)______

Where will parent(s) be while child is at camp? ______

If parents not available in emergency, Contact Person______Home #______

Must be different numbers than above. Cell #______Bus. #______

Camper lives with: Both parents Mother only Father only  Other______

Has camper been to Mariastella before? ______What year(s)? ______

Has camper been to other camps before? ______What year(s)? ______

Did camper enjoy it & why?______

Parish/Church:______School______Grade in Sept. _____

Camper’s religion: ______

What do you want your child to learn or do while at camp?______

When available, is swimming instruction desired? ______Any restrictions? ______

Is camper able to participate in hiking program? ______Any restrictions? ______

Explain restrictions: ______

Describe your child (i.e. hobbies, interests, etc.):______

______

______

WHICH CAMP SESSION DO YOU PREFER? (Indicate 1st and 2nd choice.)

1. Jul.6-Jul. 123.Jul.21-Jul. 275. Aug.2-Aug.87. Aug. 16-Aug. 22

2. Jul.13-Jul.194.Jul.29-Jul. 31 (Sibling Camp)6. Aug. 11-Aug.14 (Teen Camp)

Bus Pick-up points: Please check the CITYbelow where your daughter will board the bus, unless you will drive her.

Check here if you will drive your daughter up to camp:

Check here if you will pick up your daughter from camp:

Additional pick up points may be added if there are at least five or more campers from same location. Call camp office to arrange.

Session 1 Los AngelesUplandEncinoLakewood San Bernardino*

Session 2 Los AngelesUplandEncinoLakewoodVictorville*

Session 3Los AngelesUplandEncinoLakewoodSan Bernardino*

Session 4**Los AngelesUplandEncinoLakewoodVictorville*

Session 5Los AngelesUplandEncinoLakewoodSan Bernardino*

Session 6**Los AngelesUplandEncinoLakewoodVictorville *

Session 7Los AngelesUplandEncinoLakewood

*We will need at least 7 campers at this location to have this bus pickup

** Sess. 4 is Sibling Camp, and Sess. 6 is Teen Camp.

Camperships are available for families needing financial assistance in paying the Camp fee. If you are requesting a campership, please check here: .You will still need to send a $50 deposit with this registration form.

Total cost for the camp session is $265 per camper. A deposit of $50 (non-refundable, but applicable to total camp fee) must accompany registration papers. The camper will be registered for the session indicated, in the order in which the registration papers are received at the Camp Mariastella Office.

Photos generally taken during summer sessions may be used for promotion.I give permission for my child’s photo to be used.

Parent/Guardian Signature______Date______

Witness______Date______

OFFICE USE ONLY

Session ______Pick up:______Drop Off:______

HI CF TF

Deposit $______Check #______Date Rec’d ___/___/___ Balance Paid $______

Campership Submitted: Y / N Campership Approved: Y / N Campership Amount $______

Notes:______