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Summer Camp Registration Form

Parent Info

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent/Guardian Email*

Home Address*

Use Google Smart Search for Address

Address 1:

City:

Country:

State/Province:

Postal Code:

Parent/Guardian Work Phone* - -

Parent/Guardian Cell Phone* - -

Add a Second Parent/Guardian?*

Parent/Guardian 2 First Name*

Parent/Guardian 2 Last Name*

Parent/Guardian 2 Email*

Parent/Guardian 2 Work Phone* - -

Parent/Guardian 2 Cell Phone* - -

Emergency Contact Name*

Emergency Contact Phone* - -

Camper Info

Camper's First Name*

Camper's Last Name*

Incoming Grade*

School Attending in 2025*

Half Day or Full Day?*

Add Another Camper?*

Camper 2 First Name*

Camper 2 Last Name*

Camper 2 Incoming Grade*

Camper 2 School Attending in 2024*

Camper 2: Half Day or Full Day?*

Add A 3rd Camper?*

Camper 3 First Name*

Camper 3 Last Name*

Camper 3 Incoming Grade*

Camper 3 School Attending in 2024*

Camper 3: Half Day or Full Day?*

Choose Camp Activities

Week 1: June 24 - June 28
Week 2: July 8 - July 12

Morning Sessions: 9am - 12pm
Afternoon Sessions: 1pm - 4pm

Please check the session(s) your daughter would like to participate in:

Camper 1

Week 1 Morning Session

Week 1 Afternoon Session

Week 2 Morning Session

Week 2 Afternoon Session

Camper 2

Camper 2: Week 1 Morning Session

Camper 2: Week 1 Afternoon Session

Camper 2: Week 2 Morning Session

Camper 2: Week 2 Afternoon Session

Camper 3

Camper 3: Week 1 Morning Session

Camper 3: Week 1 Afternoon Session

Camper 3: Week 2 Morning Session

Camper 3: Week 2 Afternoon Session

Liability Release and Medical Paperwork

The medical form (for each camper) must be filled out completely and must be signed by a physician. No camper will be permitted to participate without this completed form on file. Form due by June 1, 2024.

Immunization records also have to be uploaded for each camper by June 1, 2024.

2024 Camp Medical Form

Upload your completed medical form*

(jpeg, jpg, pdf, png)

Upload your completed medical form (Camper 2)*

(jpeg, jpg, pdf, png)

Upload your completed medical form (Camper 3)*

(jpeg, jpg, pdf, png)

Upload Immunization Records*

(doc, docx, jpeg, jpg, pdf, png)

Upload Immunization Records (Camper 2)*

(doc, docx, jpeg, jpg, pdf, png)

Upload Immunization Records (Camper 3)*

(doc, docx, jpeg, jpg, pdf, png)

List any allergies (for each camper if applicable), otherwise type "none"*

LIABILITY RELEASE: Realizing that participating in activities involves the potential for injury which is inherent in all activities. I/we acknowledge that an injury is a possibility even when the necessary precautions are taken. I hold Villa Walsh Academy and its employees harmless from all causes, liabilities, damages, and claims due to an injury or accident involving my daughter while attending the Villa Walsh Academy Summer Camp on or off campus.

If a camper receives medical attention for an injury while attending camp, she must have a medical note in order to return to participate.

I have read the above statement. Parent/Guardian Signature:*

PHOTO RELEASE: I/We give permission for photo(s) | video(s) of my daughter to be published on the school social media and website. If I do not agree, I will contact the Camp Director by email at [email protected].

Photo Release:*I/We give permissionI/We do not give permission

Amount$0.00

Payment Method:*

Payment Notes/Additional Info:

Name on Card:*

Email You Want Associated with Credit Card Payment:*

Card Number:*

Exp. (MM/YY):*

CVV:*

Card Billing Zip:*

Summer Camp Registration Form

Nurturing the gifts that God gives to each student who graces our halls.

Nurturing the gifts that God gives to each student
who graces our halls.