CAMP XAVIER REGISTRATION 2025
CAMP XAVIER IS A NO-COST DAY CAMP FOR CURENT OR FORMER FOSTER YOUTH AGES 8-11. 

MONDAY, JULY 14th--FRIDAY, JULY 18th

8:30am-4:30pm

Loyola High School of Los Angeles
1901 Venice Blvd
Los Angles, CA 90006

PLEASE FILL OUT THE FOLLOWING FORM COMPLETELY.  We will send you more information about Camp Xavier as soon as we receive your registration.  THANK YOU!!

Por favor haga clic aquí para ver este formulario en español

https://forms.gle/Z5oDzvT96HsTQFv18
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Email *
CAMPER'S FIRST NAME *
CAMPER'S LAST NAME *
CAMPER'S AGE IN JULY  *
HAS YOUR CAMPER TAKEN PART IN ANY ACADEMY PROJECT PROGRAMS? (CAMP XAVIER, THE CO-OP, HOME SCHOOL, CHRISTMAS WITH THE CUBS) *
IF NOT, HOW DID YOU HEAR ABOUT CAMP XAVIER?
CAMPER'S SCHOOL AND GRADE
 (2025-2026 SCHOOL YEAR)
 *
CAMPER'S BIRTHDAY *
MM
/
DD
/
YYYY
PARENT/GUARDIAN FIRST NAME *
PARENT/GUARDIAN LAST NAME *
EMAIL *
PHONE NUMBER *
ADDRESS *
EMERGENCY CONTACT NAME AND RELATIONSHIP *
EMERGENCY CONTACT PHONE NUMBER *
2ND EMERGENCY CONTACT NAME AND RELATIONSHIP
2ND EMERGENCY CONTACT PHONE NUMBER
IS YOUR CHILD ALLERGIC TO ANY TYPE OF FOOD OR MEDICATION? *
Required
IF YOU ANSWERED YES, PLEASE EXPLAIN
PLEASE IDENTIFY ANY MEDICAL CONDITIONA OR MEDICAL HISTORY THAT WOULD REQUIRE SPECIAL ATTENTION:
PLEASE LIST  ANY ACTIVITIES CAMPER SHOULD BE RESTRICTED FROM
IS YOUR CAMPER A CURRENT OR FORMER FOSTER YOUTH? *
HOW LONG HAS/WAS YOUR CAMPER IN CARE? *
APPROXIMATELY, WHEN DID YOUR CAMPER ENTER CARE? *
MM
/
DD
/
YYYY
HEALTH INSURANCE NAME
HEALTH INSURANCE POLICY NUMBER
A copy of your responses will be emailed to the address you provided.
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