Summer Camp 2020

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

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.

Home Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Child's Full Name REQUIRED Please fill out this field. Please enter valid data.

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

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

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

Sex of Child REQUIRED Male Female Please fill out this field.

Child's Medical Information (ex. Allergies)

Child #2 Full Name Please enter valid data.

Age Please enter valid data.

Date of Birth Please enter valid data.

Grade Please enter valid data.

Sex of Child Male Female

Child'#2 Medical Information (ex. Allergies)

Child #3 Full Name Please enter valid data.

Age Please enter valid data.

Date of Birth Please enter valid data.

Grade Please enter valid data.

Sex of Child Male Female

Child #3 Medical Information (ex. Allergies)

Parent Information Married Divorced Separated Living Together Other

If other please explain:

Mom's Name Please enter valid data.

Mom Cell Phone Number Please enter a phone number.

Mom Work Phone Number Please enter a phone number.

Address (If different from above) Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Mom Email Please enter an email address.

Dad's Name Please enter valid data.

Address (If different from above) Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Dad Cell Phone Number Please enter a phone number.

Dad Work Phone Number Please enter a phone number.

Dad Email Please enter an email address.

The following person(s) may NOT pick-up my child

Permission for my child to take part in walking trips to nearby parks in Ridley Park during Camp hours, weather permitting. REQUIRED Yes No Please fill out this field.

We agree to the time of drop off and pick. Camp does not begin until 7AM and closes at 6PM. If we are late picking up are child(ren) we understand the added $15.00 fee for every15 minutes past pick up time will be added to our bill. We also undestand this could impact our enrollment at camp if we fail to pick up our children more than two times.

I Agree Please select this field.

We agree that payments are to be made on a weekly basis and if payment is not received our family is not permitted to use camp on the next business day or until our past due balance is paid in full.

I Agree Please select this field.

Registration Fee Due Now15.0

St. Madeline Parish

110 Park Street, Ridley Park, Pa

Summer Camp 2020

Summer Camp Registration