Summer Camp Registration

Student Information

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Grade in the Fall*

T-shirt Size

Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult 2XL

Phone*

Gender*

Male
Female

Current School*

City/Town of School*

Summer Camp Choices

Please check grade levels carefully and select the appropriate camps.

Camp options:

Parent/Guardian Completing This Form

Name*

First Last

Maiden Name (If Applicable)

Phone*

Email*

Are you a PCHS Graduate?*

Yes
No

PCHS Class of

Medical/Emergency Information

Please list any medical issues (eg. allergies, diabetic, etc.) or other issues that we should know about:

Medical Issues*

Emergency Contact Information

Please list an additional person o contact in case of an emergency

Name*

First Last

Phone*

Relationship to student*

Release Form

The above-named ACTIVITY PARTICIPANT agrees to defend, protect, indemnify and hold PROVIDENCE CATHOLIC HIGH SCHOOL harmless against and from all claims arising from the negligence or fault of the above-named ACTIVITY PARTICIPANT or any of his/her agents, family members, officers, volunteers, helpers, partners, organizational members or associates which arise out of the above-named SPORT/ACTIVITY at PROVIDENCE CATHOLIC HIGH SCHOOL. Additionally, the above-named ACTIVITY PARTICIPANT agrees to protect, defend, hold harmless and fully indemnify PROVIDENCE CATHOLIC HIGH SCHOOL for any claim or cause of action whatsoever arising out of the above-named SPORT/ACTIVITY which takes place during the above identified DATE(S) OF SUMMER CAMP that is brought against PROVIDENCE CATHOLIC HIGH SCHOOL by the above-named ACTIVITY PARTICIPANT or their family members whether such claim arises from the alleged negligence of PROVIDENCE CATHOLIC HIGH SCHOOL, its employees or agents or ACTIVITY PARTICIPANT’S negligence. If any portion of this agreement is held invalid, it is agreed that the balance thereof, shall continue in full legal force and effect. Photos will be taken at camps for marketing/social media purposes.

Untitled*

I agree

Name

This field is for validation purposes and should be left unchanged.