2019 SBCCC Summer Camp Registration
One form per child. If you need to make changes after submission please contact us StBridgetCCC@gmail.com
Email address *
Child Name *
Your answer
Age *
Your answer
School grade (in the coming school year) *
Your answer
Morning class, select one: *
Afternoon class, select one:
Parent's Name *
Your answer
Phone number *
Your answer
Another emergency contact name and phone
Your answer
Consent and Liability Release
I voluntarily agree to participate or for my children to participate in this or these programs. The undersigned is (are) aware that participating in these activities involves risk of injury to the above-named student. The undersigned hereby agree to assume any and all liability and agree to hold harmless and indemnify the Archdiocese of Los Angeles, its constituent organizations, including but not limited to the Roman Catholic Archbishop of Los Angeles, a corporation sole, St. Bridget Chinese Catholic Church, and all of their employees, officers, directors, agents, volunteers or affiliated entities from any and all claims, damages, injuries, accidents or incidents, whether or not caused by the negligence (active or passive), or any of the entities or individuals named or described above, which may arise or occur with respect to the above-named child during the course of the activity.
I hereby warrant and represent that the above-named child is physically fit and capable of taking part in such activity. I make this warranty and representation on the basis of advice given me (us) by a duly licensed medical doctor, and I know of no change in his/her medical condition since receiving such advice that would affect the opinion of said medical doctor.
I further agree that the above-named child will abide by the rules and regulations governing the above described activity and to obey any instructions given by the person or persons having supervision and control over the activity.
I authorize the making of photographs, motion pictures, video tapes, recordings, or other memorializing of said event and the above-named child's participation therein, and the publication or other use thereof. I hereby waive any right to compensation therefore or any right that I otherwise might have to limit or control such making or use.
Should it be necessary for the above named child to receive medical treatment while participating in this activity, I hereby give the parish personnel permission to use their judgment in obtaining medical service for my child, and I give permission to the physician selected by the parish to render medical treatment deemed necessary by the physician. I understand that any insurance benefits that are effective have limited application.

I further grant St. Bridget Chinese Catholic Church permission to use my child's photos/videos for any legal use, including but not limited to: publicity, copyright, illustration, and web content.
By checking this box, I sign this agreement and abide by all the terms listed above. *
Required
Payment
Your seat is not guaranteed until payment is received. You can:
1. Bring payment to church office M-F 9am-1pm at 445 Cottage Home St., Los Angeles, CA 90012, OR
2. Pay by Zelle, id mrpeterchan@gmail.com or 6265126872, OR
3. Pay by Venmo, id peter-chan-7, enter your child's name in "What's it for"
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