Summer Camp Schedule - OLHC

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Camper Name: ______________________

OLHC Summer Choir Camp Registration Form

Age:_____

Trained vocalist Dina Boyer will be teaching vocal technique across multiple genres. Students entering grades 2-10 during the 2018-2019 school year are welcome! Students will perform at mass on Saturday, June 23rd from 4:15-5:30, and after mass from 5:30-6:00pm.

Summer Camp Schedule June 18th-June 22nd: OPTIONAL - Before care: 7:30am-9:00am (snack not included) Session 1 (Liturgical ensemble): 9:00am-11:00am Lunch: 11:00am-12:00noon (included or pack) Choir camp: $180.00 Before care: $20.00 After care: $45.00 Completed registration form (pages 2-5) and payment in full due no later than June 1, 2018 to:

Session 2 (Secular Music): 12:00noon-2:00pm OPTIONAL - Aftercare: 2:00pm-5:30pm (snack included) June 23rd: Final rehearsal and performance: 3:30-6:00pm

Our Lady Help of Christians Parish 934 Hanover Ave. Allentown PA 18109 or submit by email to [email protected] Page 1 of 5

Camper Name: ______________________

OLHC Summer Choir Camp Registration Form

Age:_____

1: Registration Information Child

First _______________________________ Last _______________________ Gender: Male __ Female__ School Name __________________________________ Grade _______ Birth date _____/_____/______ Age (as of June 1, 2018) _____ Street Address __________________________________________________________________ Town/City ___________________________ State ______ Zip code ___________ Child’s Home Phone _______________________ Parent/Guardian - Contact Information

Parent/Guardian #1 First_______________________________________Last_________________________________ Ms. Mrs. Mr. Other _______ Street Address __________________________________________________________________ Town/City ___________________ State ___ Zip Code ________ Home Phone ________________ Work Phone _________________ Cell phone ______________________________ E-mail _______________________ Parent/Guardian #2 First_______________________________________Last_________________________________ Ms. Mrs. Mr. Other _______ Street Address __________________________________________________________________ Town/City ____________________ State ___ Zip code ________ Home Phone ________________ Daytime phone _______________ Cell phone ______________________________ E-mail _________________________________ Person responsible for payment

2: Emergency Contact Information – Alternate Pickup/Release ___________________________________________________________________________________ Emergency Contact #1 First Name ___________________ Last Name ___________________ Home Phone ________________ Work Phone ______________ Cell Phone ___________________ Email _______________________ Relation to child _________________ Emergency Contact #2 First Name ___________________ Last Name ___________________ Home Phone _______________ Work Phone _______________ Cell Phone ___________________ Email _______________________ Relation to child _________________ Please list those people including in addition to parents/guardians who are permitted to pick up your child: 1: ___________________________ 2: __________________________ 3: __________________________ Page 2 of 5

Camper Name: ______________________

OLHC Summer Choir Camp Registration Form

Age:_____

3: Medical Release Information Insurance Information Policy Number__________________________________ Name of Health Insurance Provider_______________________________ Primary Physician__________________________________________________________________________________ _________ Address___________________________________________________________________________________ ________________ Phone_______________________________________ Hospital Preference_____________________________________________ Please list any medical problems, including any requiring maintenance medication (i.e. Diabetic, Asthma, Seizures). Medical Problem _______________________________ _______________________________ _______________________________

Required treatment Should paramedic by called? _______________________ Yes/No _______________________ Yes/No _______________________ Yes/No

Is your child presently being treated for an injury or sickness, or taking any form of medication for any reason? Yes__ No__ If yes, explain:_____________________________________________________ Is your child allergic to any type of food or medication? Yes__ No__ If yes, explain:______________________________________________________ Does your child require a special diet? Yes__ No__ If yes, explain:______________________________________________________ The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

4: Emergency Contacts Name

Phone #

Relationship to Child

Contact #1 Contact #2 Contact #3 I understand that I will be notified in the case of a medical emergency involving my child. In the event that I cannot be reached, I authorize the calling of a doctor and the providing of necessary medical services in the event my child is injured or becomes ill. Parent’s/Guardian’s Initials ____________ I understand that the Summer Choir Camp, Our Lady Help of Christians Parish and its affiliates will not be responsible for the medical expenses incurred, but that such expenses will be my responsibility as parent/guardian. Parent’s/Guardian’s Initials ____________ Page 3 of 5

Camper Name: ______________________

OLHC Summer Choir Camp Registration Form

Age:_____

5: Terms of Agreement Photo Release I hereby give permission for my child to be photographed during the OLHC Summer Choir Camp. I understand the photos will be used to keep a journal of activities, to share during power point presentations and/or reports to our donors and for promotional purposes including flyers, brochures, newspaper and on the internet. I understand that although my child’s photograph may be used for advertising, his or her identity will not be disclosed, I do not expect compensation and that all photos are the property of the Summer Choir Camp, Our Lady Help of Christians Parish and its affiliates. Parent’s/Guardian’s Initials ____________ Transportation Release I hereby give permission for the transportation of my child for official OLHC Summer Choir Camp activities by modes of transportation agreed to by the camp organizers. Parents will be notified of any field trips at least 48 hours prior to planned departure. Parent’s/Guardian’s Initials ____________ The OLHC Summer Choir Camp and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change. I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness per physician orders. Childrens’ photos and quotes may be used for publicity purposes. In case of an emergency, and if a family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or Physician). Printed Name of Parent/Guardian: _______________________________________________ Guardian Signature: ____________________________________________ Date: _____________________

6: Summer Choir Camp Community Expectations The following rules and guidelines are equally binding on adult leaders/chaperones and youth. NON-NEGOTIABLE RULES Any participant failing to abide by these rules will be sent home immediately at personal/family expense. • No use of illicit drugs or alcohol • Presence at and full participation in all group activities, including adherence to all time-related instructions • No behavior that could be defined as lewd or improper in a school, camp, or other public environment. • Smoking and the use of tobacco products are not allowed at any time. • Will not break any laws: state, local, or national. CAMP COMMUNITY GUIDELINES • Adults and youth will be equally responsible for performing assigned tasks in a timely and cooperative manner. Page 4 of 5

Camper Name: ______________________

OLHC Summer Choir Camp Registration Form

Age:_____

• Participants will be respectful, encouraging, and will maintain a positive attitude toward others at all times. • Participants will be respectful of both common spaces and the property of others. • Participants will avoid the use of foul language: cursing, or any foul speech (including “humor”) which puts down, makes fun of, or stereotypes other persons or groups. Youth Participant’s Statement: By signing this form, I pledge to respect others during this activity by following the rules and guidelines printed above. I understand that I cannot participate in the activity unless this completed form is on file. x_________________________________________________________________________ Youth Participant’s Signature Date Parent/Guardian’s Statement: By signing this form, I agree to support the Community Expectations printed above, and will accept responsibility for the payment of my child’s return transportation should s/he break one of the non-negotiable rules. x_____________________________________________________________________________ Parent/Guardian’s Signature Date

7: Payment Information STUDENT IS REGISTERING FOR (CHECK ALL THAT APPLY):

□S

Completed registration form (pages 2-5) and payment in full due no later than June 1, 2018 to:

UMMER CHOIR CAMP ($180.00)

9:00AM-2:00PM M-F; SATURDAY, 3:30PM-6:30PM

□B

□A

7:30AM-9:00AM M-F

2:00PM-5:30PM M-F

EFORE CARE ($20.00)

FTER CARE ($45.00)

Amount enclosed $ ____________________Check/ Money Order (Checks payable to: Our Lady Help of Christians Parish) I authorize the following amount to be charged to my: $_____________________

Our Lady Help of Christians Parish 934 Hanover Ave. Allentown PA 18109 or submit by email to [email protected]

□Visa □MasterCard □Discover

Credit card: Cardholder’s Name________________________________ Account #_______________________________ Expiration Date___________________ Cardholder’s Signature_____________________________________

Page 5 of 5

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Summer Camp Schedule - OLHC

Camper Name: ______________________ OLHC Summer Choir Camp Registration Form Age:_____ Trained vocalist Dina Boyer will be teaching vocal technique...

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