Bishop Shanahan High School

Contact Information

Child’s Full Name: *

(First, Middle and Last)

Gender:

Date of Birth: *

Grade Level for Sept. 2026:

Home Address:

City:

State:

Zip Code:

Home Phone:

Father/Guardian’s Name:

Father/Guardian’s cell phone:

Father/Guardian’s Email:

Mother/Guardian’s Name:

Mother/Guardian’s cell phone:

Mother/Guardian’s Email:

Dismissal Policy:

Transportation (MOU): *

I give my permission for the persons named below to transport my child to and from BSHS Summer Camp.

*

I understand that my child will not be released to anyone who is not listed below.

Name: *

Relationship: *

Cell Phone: *

Name: *

Relationship: *

Cell Phone: *

Name: *

Relationship: *

Cell Phone: *

Name: *

Relationship: *

Cell Phone: *

Name: *

Relationship: *

Cell Phone: *

The mode of transportation to and from camp? *

Emergency Information:

In case of emergency, my preference is? *

Text me at:

Call me at:

If we are unable to reach you, whom should we contact?

Emergency Contact Full Name #1: *

Relationship: *

Phone Number: *

Emergency Contact Full Name #2: *

Relationship: *

Phone Number: *

Consent for Medical Care: *

I understand that I will be notified in the case of a medical emergency involving my child. In the event that I or the emergency contacts cannot be reach, I authorize a call may be made to 911 for emergency medical attention.

*

I understand that the Archdiocese of Philadelphia will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian.

Medical/Learning Data
If any of the following categories apply to your child, please list his/her name and give details in the appropriate spaces.

Child's Name:

Medical Conditions/Allergies:

Prescribed Medications:

Disability/Learning Support Services:

Individualized Education program (IEP):

If your student carries an EpiPen, please indicate if he/she is able to self-administer?

T-Shirts will be provided for each cheer camper. Please indicate their size. *

Comments/Questions:

Are there any additional comments or information that we should know (ex.: allergies, custody issues, etc.)?

Media Consent: *

Bishop Shanahan High School and the Archdiocese of Philadelphia have my permission to use my child’s photograph publicly to promote BSHS Summer Camps. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use.

Code of Conduct (MOU): *

In order to ensure a safe, secure and respectful environment, a student participant is expected to behave in a manner which reflects Christian virtue and Gospel values. Any behavior which is contrary to the teachings of Jesus Christ will not be tolerated. Appropriate disciplinary actions will be taken by the Camp Director which may include the immediate dismissal of the student participant. Inappropriate behaviors include but are not limited to bullying, harassment, intimidation, threats to BSHS Summer Camp staff and/or student participants, vandalism and/or the carrying of contraband.

Back packs are permitted. If, however, there is a reasonable suspicion that the student participant is carrying contraband, the BSHS Summer Camp staff will search the back pack and seize the contraband. Contraband includes but is not limited to illegal drugs, drug paraphernalia, weapons, and alcohol. If the student participant refuses to cooperate or the contraband discovered poses immediate danger to others, the police will be notified.

For safety reasons, student participants are permitted to carry their own cell phone, but may not use them during the day. The phone be confiscated if this policy is violated. No other electronic devices permitted.

Memorandum of Understanding (MOU): *

I have read and agree to the terms of BSHS Summer Camp as listed in the Memorandum of Understanding (MOU)

Participant Release, Waiver of Liability, and Indemnity Agreement

I have voluntarily applied to have my child (the “Participant”) participate in the BSHS Summer Camp occurring during the Summer of 2025 (the "Activity”) which is sponsored and/or supervised by or taking place at Bishop Shanahan High School (the "Location") and I agree as follows:
Acknowledgments: (1) I am participating in the Activity of my own free will; (2) I understand the nature of the Activity; and (3) I am qualified, in good health, and in proper physical condition to participate in the Activity.
Assumption of Risk: (1) I know that the Activity may present (a) risks of injury or illness (INCLUDING FROM COVID-19) that could result in death and/or (b) risks of loss of or damage to my property and (2) I agree to assume those risks and any other unknown risks; and (3) I accept the Location, the Archbishop of Philadelphia, and the Archdiocese of Philadelphia and any lessor of the premises have no obligation to provide me with any insurance or other financial assistance for the costs of any injury, illness, or death or loss of or damage to property resulting, directly or indirectly, from the Activity and I expressly waive any claim for such compensation.
Waiver and Release: l, on behalf of myself, my heirs, next of kin, spouse, and legal representatives, hereby release, waive, discharge from, and agree not to sue the Location, the Archbishop of Philadelphia, and the Archdiocese of Philadelphia and any lessor of the premises, along with their respective affiliates, successors, and assigns, and their respective members, directors, officers, employees, volunteers, agents, contractors, and representatives (collectively "Released Parties") for any and all claims, costs, liability, or damages of any injury, illness, death or loss of property resulting, directly or indirectly, from the Activity except if caused by the gross negligence or intentional misconduct of any of the Released Parties which shall not be imputed to the other Released Parties.
Indemnity: If, despite the Waiver and Release above, I or anyone on my behalf makes a claim against any of the Released Parties, I will indemnify, save, and hold harmless each of the Released Parties from any litigation expenses, attorney fees, loss, liability, damage, judgment or cost which may be incurred as the result of such claim.
Severability: This Participant Release, Waiver of Liability, and Indemnity Agreement is intended to be as broad and inclusive as is permitted by applicable law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

Participant Waiver Release: *

MINOR RELEASE: I, the parent or guardian of the participant, have read this participant release, waiver of liability, and indemnity agreement and fully understand it's terms. I understand that I am giving up substantial rights I and/or the minor would otherwise have, including the right to sue. I acknowledge that by checking this box I am signing this agreement freely and voluntarily, and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.