Pope John Paul II High School

STEP ONE
ENTER INFO
STEP TWO
CONFIRMATION
STEP THREE
RECEIPT

CAMP CARITAS
at
PJP II

Camper Registration Form

June 24th - June 28th

CAMP CARITAS IS FOR 7TH AND 8TH GRADE STUDENTS

PREPARING FOR THE SACRAMENT OF CONFIRMATION

Welcome to the Registration page for Camp Caritas held at Pope John Paul II High School. We look forward to your child being a part of this unique, fun and educational summer program!

In order to complete this form, please note that your student must be a registered member of an Archdiocesan parish and entering Grade 7 or 8 for the 2024-2025 school year. Registration is on a first-come basis. Registration will close once 200 students have been registered.

Camp Caritas June 24 - June 28

Qty

Description

Amount

Total

Camper Registration

$200.00

---

Total: $0.00

Camper Information

Camper First Name: *

Camper Last Name: *

Gender: *

Birth Date: *

(MM/DD/YYYY)

T Shirt Size *

Grade Level (Sept. 2024): *

Current School: *

Parish *

Home Address *

City *

Zip Code *

Parent Contact Information

Father/Guardian's Name: *

Father/Guardian's - Cell Number: *

Father/Guardian's- Email *

Mother/Guardian's Name: *

Mother/Guardian's - Cell Number *

Mother/Guardian's- Email *

Dismissal Policy

Transportation (MOU) *

I give my permission for the person(s) named below to transport my child to and from Camp Caritas

Check: *

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

Name *

Relationship to Camper *

Cell Phone *

Emergency Information

In case of emergency, contact me at: *

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

Emergency Contact Full Name *

Relationship to Camper *

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 reached, I authorize a call may be made to 911 for emergency medical attention.

Waiver: *

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.

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?

Additional Information

Comments/Questions

Media Consent *

Pope John Paul II High School and the Archdiocese of Philadelphia have my permission to use my child's photograph publicly to promote Camp Caritas. 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 *

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 Camp Caritas staff and/or student participants, vandalism, and/or the carrying of contraband. Backpacks are permitted. If, however, there is a reasonable suspicion that the student participant is carrying contraband, the Camp Caritas 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.

Code of Conduct Agreement *

I have read and agree to the terms of Camp Caritas as listed in the Code of Conduct.

Payer Information

First Name: *

Last Name: *

Billing Address: *

This is the address where your credit card statements are mailed.

Address 2:

City: *

State / Province: *

Zip Code: *

Country: *

Primary Phone: *

Camp Waiver *

I authorize the Pope John Paul II High School Camp Caritas Staff to act for me in an emergency situation that requires medical attention for my son or daughter. Pope John Paul II High School shall not be held responsible for clothing or personal possessions lost or damaged by fire, theft, malicious mischief, or personal negligence. I hereby waive and release Pope John Paul II High School from any and all injuries or illnesses incurred while going to camp from home, while at camp, or returning from camp to home.

E-mail: *

A receipt will be e-mailed to this address.

Your Payment Information

Name on Card: *

Card Number: *

Security Code: *

Expiration Date: *