1 Child - $150

2 Children - $300

3 Children - $350

4 Children - $400

CAMP DATES: July 28th - August 1st

CAMP HOURS: 9am - 12:30pm

Registration is complete only when this form and payment are completed.

Camper's First Name *

Camper's Last Name *

What school will the Camper be attending in the fall? *

Grade Camper is entering in Fall 2025? *

Camper T-Shirt Size *

Home Address *

City *

Postal Code *

I hereby authorize the Parish to use my camper's following personal information about my child on the parish website and end of week VBS slideshow: *

Primary Contact Full Name *

Primary Contact Phone Number *

I agree to terms & conditions provided by St. Mel. By providing my phone number, I agree to receive text messages from Vacation Bible School.

Primary Contact Email *

Would you like to add a secondary contact? *

Yes

Secondary Contact Full Name

Secondary Contact Phone Number

Secondary Contact Email

Emergency Information

Name of Emergency Contact *

Emergency Contact Phone Number *

Camper Medical Information

Please list any physical/medical conditions that our volunteers should be aware of that would prevent your child from fully participating in this activity:

*If no physical or medical conditions type N/A

Dietary Restrictions or Food Allergies our volunteers should be aware of:

*If no dietary restrictions or allergies type N/A

Health Insurance Name *

Health Insurance Policy Number *

Medication Authorization: If my child needs to take medication while participating in this activity, I hereby give my child permission to self-administer his/her medication in accordance with the Medication Authorization and Permission Form, and, if my child cannot self-administer, I give permission to the responsible staff members or chaperones to administer or to assist in the administration of my child’s medication. I also give permission to the responsible staff members, chaperones, medical practitioners and medical facilities to use their judgement in obtaining and providing medical treatment for my child should it become necessary to do so. I understand that health insurance benefits through the Location, if any, may have limited application, and that I am entirely responsible for the cost of all medical treatment provided to my child. I agree to reimburse the Location for the cost of any medical treatment and related expense incurred.

Release of Liability: As a condition of participating in this activity, I hereby hold harmless, release and discharge The Roman Catholic Archbishop of Los Angeles, a corporation sole, Archdiocese of Los Angeles Education & Welfare Corporation and the Location, their respective agents and employees and any parent/volunteer/chaperone, from any and all liability, loss or claims for personal injuries, wrongful death or property damage that I or my child may suffer as a result of participation in the activity described above.

I, Parent/Guardian of above Camper, have read this Authorization, understand the contents and am able to grant the rights and waivers it contains. I understand that the terms of this Authorization are contractual and not mere recitals. I am signing this document freely and voluntarily.

Sign Below: *

Clear

Would you like to register another child?

Yes