REGISTER FOR CAMP PURPLE SUMMER CAMPS

CAMPER INFORMATION

SELECT CAMP(S)

Enrichment Camps

Athletic Camps

CAMPER MEDICAL CONDITION INFORMATION

I hereby warrant that to the best of my knowledge, my child is in good health, and I assume all responsibility for the health of my child. No medication of any type, whether prescription or non-prescription, will be administered to my child unless the situation is life-threatening and emergency treatment is required.

**The school will take reasonable care to see that this information is held in confidence.

Would you like to register another camper?

FAMILY CONTACT INFORMATION

ex. (###) ###-####

FAMILY MEDICAL & EMERGENCY CONTACT INFORMATION

Emergency Medical Treatment: In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor. In the event of an emergency, if you are unable to reach me at the above numbers, contact:

ex. (###) ###-####

In the event it comes to the attention of Guerin Catholic directors and agents, and the Diocese of Lafayette-in-Indiana, coaches, chaperones, or representative associated with the activity that my child becomes ill with symptoms such as headache, vomiting, sore throat, fever, diarrhea, I will be called.

I understand that photos will be taken during the Camps and used for Camp Purple promotional materials and advertising. I understand that my child’s name will not be identified with any photos.

I grant permission for my child(ren) to participate in Camp Purple. This activity will take place under the guidance and direction of all instructors who have met the screening and approval of Guerin Catholic High School.

As parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named minor (“participant”).

I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Guerin Catholic, its officers, directors and agents, and the Diocese of Lafayette-in-Indiana, coaches, chaperones, or representatives associated with the event, arising from or in connection with my child attending the event or in connection with any illness or injury or cost of medical treatment in connection therewith, and I agree to compensate the school, its officers, directors and agents, and the Diocese of Lafayette-in-Indiana, coaches, chaperons, or representatives associated with the activity for reasonable attorney’s fees and expenses arising in connection therewith.

Payment will not go through if the credit card address is different from the campers address. This is a credit card company process to help ensure no fraudulent charges.
Total: $0.00

Credit Card Details

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