2018 Camp Dates:

• June 11th - 15th

• June 18th - 22th

• June 25th - 29th

9:00a.m. to 3:00p.m.

Sign up by

May 25th to receive

a Camp t-shirt!

St. Peter the Apostle School

7020 Concord Road

912.897.5224

http://school.saintpetertheapostle.com

Register Today

For only $25 Fee included in

cost of camp.

Ages/Grades: Rising Pre-K 4 through rising 6th graders Cost: $135 per week Drop Off: 9:00a.m.

7:00 - 9:00am - $15week 3:00 - 5:00pm - $15/week Both for $25/week Topics:

American Girl, and more! Campers will experience a variety of activities each day taught by our St. Peter’s teachers! Lunch: Bring a bag lunch. Snacks provided. Attire: Wear a swim suit to camp each day. Bring a towel and a change of clothes.

St. Peter the Apostle School 2018 Summer Smart Camp Registration Form

Student’s Name _________________________________ Rising Grade: ______ Age: _____ Gender: _______

Date of birth ___________________________________ T-shirt Size (please circle one): YS YM YL AS AM

Parent’s Name ___________________________________ Home Phone # _______________________________

Email Address ________________________________________________________________________________

Address ____________________________________________________________________________________

Mom’s Cell Number: ______________________________ Dad’s Cell Number: ___________________________

Mom’s Work Number: ____________________________ Dad’s Work Number: __________________________

Emergency Contact: ______________________________ Home Phone Number: _________________________

Work phone Number: ____________________________ Cell phone Number: __________________________

Is there anyone that to whom you do NOT wish your child to be released? _______________________________________

I submit this registration form and request that this student attend SMART Camp at St. Peter the Apostle School. I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Peter the Apostle School, its officers, directors, employees and agents, chaperons, or representative associated with the event, from any claim arising from or in connection with my child attending the event or in connection with any illness or injury (including death) or cost of medical treatment in connection therewith, and I agree to compensate the school, its officers, directors and agents, and the Diocese of Savannah, its employees and agents and chaperons, or representatives associated with the event for reasonable attorney’s fees and expenses which they may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the school/diocese. I will cooperate with the spirit and regulations of the school. In signing this registration form, I give the school assurance that I understand and will abide by these requirements.

Special Circumstances: Parents and guardians are required to inform SMART Camp in writing of any special circumstances which

may affect the child’s ability to participate fully and within the guidelines of acceptable behavior. To ensure your child’s safety and

for proper staffing, we reserve the right to rescind any application based on our ability to accommodate your child.

Parent signature ___________________________________________________________ Date ______________________

St. Peter the Apostle School • 7020 Concord Road • Savannah, Georgia 31410

912.897.5224 • http://school.saintpetertheapostle.com

June 11-15

Camp

June 18-22

Camp

June 25-29

Camp

Extended Care

Morning Afternoon

Check boxes

that apply

Persons Authorized to Pick up Student Relationship to Student

St. Peter the Apostle School 2018 Summer Smart Camp

Health Information and Medical Consent

Student name: ____________________________________________________________________________

Physician’s name: ______________________________________________ Phone #: _______________

Dentist’s name: ________________________________________________ Phone #: _______________

Insurance Carrier: ______________________________________________ Policy # _______________

Phone# ________________

Please note which non-prescription medications MAY BE dispensed to your child at school:

Tylenol: yes ___ no ___ Motrin: yes ___ no ___

Tums: yes ___ no ___ Benadryl yes ___ no ___

Neosporin: yes ___ no ___ Cough Drop: yes ___ no ___

Allergies: _______________________________________________________________________________

Health concerns at camp: ___________________________________________________________________

Medications currently taken by student: ________________________________________________________

If regular/daily medication needs to be given during camp hours, please contact St. Peter the Apostle School to get a “Consent to Give Medication Form.”

Permission forms (initial all that apply):

St. Peter the Apostle SMART Camp may apply bug spray: yes _______ no _______

St. Peter the Apostle SMART Camp may apply sun screen: yes _______ no _______

St. Peter the Apostle SMART Camp may photograph student for website: yes _______ no _______

St. Peter the Apostle SMART Camp may photograph student for advertisement: yes _______ no _______

Consent to Treatment:

In the event that reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the ad-ministration of any treatment deemed necessary by the physician/dentist listed above; or in the event the designated preferred practitioner is not available by another licensed physician/dentist; and transfer of my child to the hospital listed above or any hospital reasonably accessible. I accept full financial responsibility for the payments of all charges

made for medical services rendered. I absolve school officials of any liability who in good faith comply with this request.

In the event of a less serious accident/illness, if I cannot be reached, the emergency contact(s) listed above will be called. These persons may transport my child from the school premises and may assume responsibility for my child until I

can be reached.

Refusal of Consent I do NOT give consent for emergency treatment of my child. In the event of illness or injury requiring immediate treatment,

I wish the school authorities to take the following action: _______________________________________________ ________________________________________________________________________________________

Parent/Legal Guardian signature: _____________________________________ Date: __________________