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REGISTRATION FORM Please make sure you have filled in ALL the blank spaces. Please PRINT information. Thank you. Our KIDS Care Camp is for students who will be going into grades 3 through 5 in September 2008. Family’s Last Name: ________________________________________________________________ Student’s Name: ___________________________________________________________________ Upcoming Grade (Sept 2008) _________ School ______________________________________ Birth date: ___________ Special Health Concerns/Confidential_____________________________ Address: _________________________________________________________________________ City:___________________________ Zip ____________ Phone# _________________________ Mother’s Name: _________________________________ Work Phone_______________________ Father’s Name: __________________________________ Work Phone______________________ Emergency Contact: ______________________________ Relationship ______________________ Phone # ____________________________ Can your child swim? ____________________ Please List All Allergies (Use other side if needed) ________________________________________ _________________________________________________________________________________ ₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪₪ An additional Liability Release Form and Parental Consent Form will be sent to all registered participants. These forms must be filled out completely for each child. Proof of Medical Insurance will be required for all campers. Send ALL REGISTRATIONS TO: St. Thomas of Villanova Parish Attn: Anne Murphy 1229 W. Lancaster Ave., Rosemont Pa 19010 Space Is Limited. Camp will fill up on a first come, first serve basis. For additional information, contact Anne Murphy @ 610-525-4801 or e-mail anne.murphy@stthomasofvillanova.org |
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Our Mother of Good Counsel and St. Thomas of Villanova Parishes July 7-11, 2008 10: 00 am to 2: 00 pm, Monday-Friday. OMGC will serve as our base camp for the week. |
