Bishop Shanahan High School

Contact Information

Child’s Full Name: *

(First, Middle and Last)

Gender:

Date of Birth:

Grade Level for Sept. 2024:

Name of Day School, City or Town:

Name of Parish, City or Town:

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 Camp Caritas.

*

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 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 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 (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 Camp Caritas 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 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.

Memorandum of Understanding (MOU): *

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