2023 Summer Programs Registration

Student Information

Student Name

Date of Birth

Gender

Male
Female

Grade in Fall 2023

Please note that participation for grades 9-12 is limited to St. Dominic High School students.

School

Parish

T-Shirt Size

Select Programs

Please select all programs for which you wish to register this student. You will have the option to add additional students in a later step. Please note that participation for grades 9-12 is limited to St. Dominic High School students.
*Camp Fees are Non-Refundable.*

Sports Programs

Photo Release

Yes
St. Dominic High School MAY use my child’s image to promote SDHS summer programs in print/electronic media.
No
St. Dominic High School MAY NOT use my child’s image to promote SDHS summer programs in print/electronic media.

Medical Release

I hereby authorize the director and/or staff of the St. Dominic camp to act for me according to his/her best judgment in an emergency requiring medical attention. I know of no mental or physical problems that might affect my child’s ability to safely participate in this camp. I will be responsible for any medical care or any changes in connection with his/her attendance at camp. I agree to abide by the rules and regulations of the camp.

I have read and agree to the terms above.

Insurance Company

Policy Number

Parent Information

Parent 1 Name

Parent 1 Email

Parent 1 Phone

Parent 2 Name

Parent 2 Email

Parent 2 Phone

Primary Address

Emergency Contact Name

Daytime Phone Number

Relationship to Student

Total

Coupon Code

Student Subtotal

$0.00

Total

$0.00

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