2026 Summer Camp Registration

Camper Information: (please fill out a form for each child)

First name

Last name

Birthday

Month

Day

Year

Gender

Age (at time of camp)

Grade (entering this fall):

Shirt Size:

Will your child be bringing any medications with them to camp?

Yes

List Any Allergies and Dietary Restrictions

Does your child have any accessibility requests? If so, please list them:

Is there anything else you want us to know about your child? (this is confidential):

Parent/Guardian Information:

Parent/Guardian Name #1

Parent/Guardian Name #2 (if applicable)

Phone

Secondary Phone

Address

Emergency Contact/Authorized Pickup Person:

Name

Phone

Relationship with the Camper

Release of Liability

I acknowledge and agree that:

By virtue of my child’s participation they risk serious bodily injury.
I knowingly and freely assume all such risk.
I (we), the undersigned parent(s)/guardian(s) do release, hold harmless and promise not to sue St. Bartholomew's Episcopal Church, their officers, agents, employees and volunteers, with respect to any and all such injury, except that injury or loss which results from the gross negligence or willful or wanton misconduct of one of those individuals or organizations.
I will inform my child that he/she must follow all safety rules and instructions or directions given during participation in the event, and that my child’s failure to follow instructions may result in my obligation to retrieve my child if requested. Additionally, I will not allow my child to attend if there are signs of illness.
My child and I (we) realize that participation in the program is voluntary.
My child will abide by the code of conduct.

Filming and Photo Release:

I hereby grant to St. Bartholomew's Episcopal Church and to its employees, agents, assignees, chaperones the right to photograph and film my dependent and use the photo and or film or other digital reproduction of them or other reproduction of their physical likeness for publication processes, whether electronic, print, digital, or electronic publishing via the internet. Pictures of children will never be tagged by name.

Filming and Photo Release

Grant

Do Not Grant

Parental Consent:

This is to certify that as a parent/guardian of this participant, I do consent to their waiver and release as set forth above. I also affirm that all information on the registration form is accurate.

I agree

Code of Conduct:

All participants are expected to support our community by following the guidelines below:

I will follow all schedules, rules, guidelines and emergency procedure plans of the program and facility.
I will report any emergencies, concerns and safety issues immediately to adult leaders or chaperones.
I will not bring technology to camp. This includes phones, tablets, laptops, and handheld gaming devices.
I will behave in a manner as not to hurt anyone verbally, emotionally, or physically.
I will not use profanity and other unacceptable language.
I will use kind words and language and not behave in a manner as to not put down, ridicule or make fun of another person.
I will work towards making the event a good and safe time for everyone
We have read and agree to comply with the code of conduct. We understand that breaking the code of conduct will result in consequences up to and including a parent coming to pick me up from camp.

I agree

Camp Payment

Camp Fees:

Camp Registration$300

Sibling Discounted Fee$270