Sacred Heart Parish

Summer Day Camp Registration

Please fill out completely and return by May 15, 2017

1st Child’s Name / Date of Birth
GenderMaleFemale / Grade in Fall
2nd Child’s Name / Date of Birth
GenderMaleFemale / Grade in Fall
3rd Child’s Name / Date of Birth
GenderMaleFemale / Grade in Fall

Home Address: ______Apt ______

City: ______State: ______Zip: ______

Mother’s Name: ______Work Phone: ______Cell Phone: ______

Email: ______

Father’s Name: ______Work Phone: ______Cell Phone: ______

Email: ______

Emergency Contact (Other than parent): ______

Emergency Contact Phone: ______Relationship to Camper: ______

Are you willing to volunteer one or more days per week to help run our program? YesNo

Select Desired Week(s)

July 10-14
Science! / July 17-21
Crafty Campers / July 24-28
Wet & Wild / July 31-Aug 4
Creative Thinkers / Aug 7-11
Animals / Aug 14-18
Fun in the Sun
Camper 1
Camper 2
Camper 3

Fees per camper:

Week by Week / 6 Week Discount
1 Camper / $250 per week / $1,390 for 6 weeks
2 or More Campers / $230 per week / $1,250 for 6 weeks

Weeks attending ______

# of Campers ______

Cost per week$______

Special Instruction$______($50 per week, per camper)

Total Due$______

$100 deposit per family due by May 15, payment in full due by June 30.

PLEASE NOTE:

  1. Program changes prior to the start of camp are subject to availability and must be submitted in writing to the office.
  2. These rates include all weekly specials (i.e., swimming, field trips, and transportation to these programs)
  3. Payment schedule

$100 deposit per family is due by Monday, May 15, 2017.

Payment in full, including additional fee for Special instruction in guitar, is due by Friday, June 30,2017.

All fees, including tuition, registration fees(if applicable), must be prepaid before the first day of camp!

  1. Payment method – We accept cash, or checks, payable to Sacred Heart Parish.
  2. Any payment not received on time, according to the payment schedule above, will be subject to a $25 per week per child late fee.

PLEASE KEEP A COPY OF THESE FORMS FOR YOUR RECORDS

By signing below, permission is also granted to Sacred Heart Parish for my child(ren) to go on trips or activities, including but not limited to swimming, off campus with authorized staff members. Permission is given to Sacred Heart Parish to use photography, parent endorsements and campers information in its advertising, brochures, Facebook, website and camp newsletters. Sacred Heart Parish is not responsible for any camper’s items that are damaged, lost or stolen. Cell phone use by campers is NOT permitted without camp staff member’s supervision. It is understood that Sacred Heart Parish reserves the right to dismiss without refund, any camper whose conduct is considered detrimental to the safety and/or well being of any other camper and/or staff member. Any disputes between Sacred Heart Parish and parents will be settled in the jurisdiction of Sacred Heart Parish’s choosing. My signature binds me to the payment contract and the selected schedule of days that I chose. I have read and agree to all the terms in this summer camp enrollment form

Parent Signature Date