Summer Camp 2023

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Male/Female REQUIRED Male Female Please fill out this field.

Entering Grade for Fall 2023 REQUIRED Please fill out this field.

School this student will be attending in Fall 2023 REQUIRED Please fill out this field. Please enter valid data.

Mailing Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Medical Information REQUIRED No, my child has no condition(s) which requires special awareness (including allergies) Yes, my child has a condition(s) which requires special awareness (including allergies) Please fill out this field.

Please list all current medical conditions (i.e. asthma, allergies to foods/drugs/environment/bee stings, diabetes, seizures, attention deficient, depression/psychiatric conditions) or other. Also list any medications taken on a regular or “as needed” basis:

Medical Conditions and Medications REQUIRED Please fill out this field.

In case of illness, injury, or an emergency, use the following priority to contact a parent/guardian or alternate adult. I also grant the school permission to release my child/ren to the alternate named adults:

Emergency Contact Information 1 REQUIRED

Please include name, relationship to child, phone number

Please fill out this field. Please enter valid data.

Emergency Contact Information 2 REQUIRED

Please include name, relationship to child, phone number

Please fill out this field. Please enter valid data.

Emergency Contact Information 3 REQUIRED

Please include name, relationship to child, phone number

Please fill out this field. Please enter valid data.

Please select which week(s) this child will be attending REQUIRED Please fill out this field.

St. Joseph School

A Place With Heart

Summer Camp 2023

summer camp Forms 2023