St. Thomas Summer Camp Registration Form
Please fill out one form for each student. Filling out this form does not reserve your spot. Please send all money to the school office by 4/28/17.
Email address *
Participant Name: *
Your answer
Gender *
Participant Grade Level for the 2017-2018 School Year *
Camps Participant is interested in: *
Shirt Size *
Parent Name or Guardian: *
Your answer
Phone Number *
Your answer
Email Address: *
Your answer
Emergency Contact: *
Please list someone other than parent listed above.
Your answer
Emergency Contact Relationship: *
Your answer
Emergency Contact Phone Number: *
Your answer
Does your Child have any Allergies or medical conditions we need to be aware of? *
If yes, list all allergies and/or medical conditions below.
Please give as much detail as possible.
Your answer
Please sign your name below to accept these terms: *
As parent and/or legal guardian, I remain legally responsible for any personal actions taken be the above named minor (“participant”). I am aware that participating in sports will involve travel to practices and games. I acknowledge and accept the risks involved with my child’s travel. I further understand that participation in sports presents to my child the risk of harm, including, but not limited to, serious personal injury or death. Any questions I have concerning my child’s participation have been answered. In consideration of my child being allowed to participate in the sport(s) indicated above, I hereby RELEASE AND AGREE TO INDEMNIFY AND HOLD HARMLESS the Catholic Diocese of Peoria, the parish, the school, coaches, chaperones, volunteers or representatives associated with the event, and their employees and agents, from any and all liability for injuries, damages, medical expenses, or any other loss to my child or family or me (including attorneys’ fees) arising from or related to my child’s participation. Additionally, I give my consent and approval for my child’s name and picture to be printed in any sports program, publication, or video. As a parent/guardian, I further acknowledge that I am a role model. I will remember that school athletics is an extension of the classroom, offering important learning experiences for the students. Therefore, I will show respect for all players, coaches, spectators, and officials. I will only participate in cheers that support, encourage, and uplift the teams involved. I understand the spirit of fair play and good sportsmanship expected by a Catholic school, and accept the responsibility that comes with being a parent/guardian of a student athlete.
Your answer
A copy of your responses will be emailed to the address you provided.
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