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CATHOLIC KIDZ CAMP: JUNE 15 – 19 from 9 am – 12:15 pm* *Camp will end at 1 pm on Friday, June 19th; following a closing program performance. Kids will be given an extra snack on Friday. REGISTRATION FORM FIRM REGISTRATION DEADLINE: MONDAY, April 20 th*
*Enrollment is limited & may fill prior to April 20 th .
Priority will be given to St. Catherine of Siena parishioners. W ait lists will be available if registration fills.
Parent/Family Name: ____________________________________________________________________________________________
 YES  NO
ARE YOU A REGISTERED MEMBER OF ST. CATHERINE OF SIENA?
If no, where do you attend church? ___________________________________________________________________________________
Are you, or another member of your family, able to volunteer your time during the week of CKC 2015?
(See attached for more information. Please fill out a volunteer registration form for each volunteer.)
 YES  NO
Preferred Phone: _______________________________ Email Address: _____________________________________________________
CAMPER REGISTRATION: $25 per CAMPER Please check the grade that your child will be in for the upcoming 2015/16 school year.
While age/grade will be taken into consideration when creating groups, the final groups will be formed
based on the number of total campers registered. Groups WILL likely consist of varying ages/grades.
Office Use Only: __________Cash __________Check Number __________Outstanding __________Date Received CAMPER NAME(S) GEN-‐
DER M F 2015/2016 SCHOOL YEAR 1st YOUTH T-‐SHIRT SIZE nd
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2 3 4 5 XS S M L Child Name 4 K yr. Child Name Child Name Child Name {OVER FOR PAGE 2} Registration fee: $25 per camper
Registration fee includes a camp t-shirt to wear daily, a music CD, and daily craft and snack supplies.
{Scholarships are available for those in need of financial assistance. Contact Danielle Holtzman at 613-2818} Number of campers * $25 = TOTAL Payable to Saint Catherine of Siena ___________ * $25 = $_____________________ Please return completed form & payment to the church office no later than APRIL 20TH. Please note that space is limited and registration may fill prior to April 20th. ALLERGY ALERT Please list allergy information, food or medical, for any affected campers.
CAMPER NAME
ALLERGY INFO
SPONSORSHIP ADVERTISING OPPORTUNITY Do you own a business that would enjoy advertising through Catholic Kidz Camp?
CKC offers three levels of sponsorships with varying levels of promotion/advertising.
In exchange for a sponsorship of cash or goods, your business logo will be largely and visibly
screen-printed on the back of the CKC T-shirts worn daily by the campers, in addition to other
mediums of recognition and promotion.
 Yes!
I am interested in more information about
sponsorship opportunities. Please contact me.
Business Name __________________________________________
Contact Person __________________________________________
Phone __________________________________________________
Email __________________________________________________
T-‐SHIRT BACK FROM 2014 PLEASE BE SURE TO SIGN THE LIABILITY WAIVER ON PAGE 3 TO COMPLETE REGISTRATION. {OVER FOR PAGE 3} PERMISSION SLIP & LIABILITY WAIVER As the parent/legal guardian of ________________________________________________________________________________________, I am in complete understanding that my son/daughter is participating in Catholic Kidz Camp sponsored by Saint Catherine of Siena Catholic Church. I fully understand and choose not to, and will not hold the Saint Catherine of Siena Catholic Church, any of their agents, assigns, employees, or volunteer sponsors (hereafter referred to as sponsors) liable for any accidents, injuries or any other unforeseen harms incurred at any time while participating in this activity, except in the case of gross negligence. I authorize Saint Catherine of Siena Catholic Church and their sponsors to find adequate and reasonable medical treatment at my expense, if the need arises. This waiver will serve as a medical release form, thus authorizing the sponsor permission to act on my behalf until such a time that I can be contacted. I understand that by signing below, as the parent/legal guardian, I agree to and will adhere to the preceding statements and grant permission for my child to participate in this activity (Signing below does not nullify your rights granted to you by local, state, and federal laws). Also, I understand that my child will not be allowed to participate if this completed form does not accompany him/her before the activity begins. PARENT/GUARDIAN SIGNATURE DATE EMERGENCY CONTACT INFORMATION Primary Contact Name ________________________________________Primary Contact Phone ____________________________________ Secondary Contact Name _____________________________________Secondary Contact Phone__________________________________ Medical conditions we should be aware of _____________________________________________________________ SPECIAL NEEDS or ASSISTANCE Please list any special needs or assistance that you or your camper(s) may require. Office Use Only: _________ Liability Waiver _________ Payment
________Date Received _________ Volunteer Registration {OVER FOR VOLUNTEER REGISTRATION} CKC 2015 VOLUNTEER REGISTRATION PLEASE FILL OUT A SEPARATE FORM FOR EACH INDIVIDUAL VOLUNTEER!  VOLUNTEER NAME_____________________________________________________________________  M  F
 My child(ren)/grandchild(ren) is/are registered in CKC 2015 under the last name: ________________________  I am a middle/high school aged volunteer (Minimum age requirement is 6th grade in 2015/16 school year.)
Age: ____________________________ Grade for 2015/2016 School Year:_________________________________  If you are over the age of 18, are you VIRTUS trained?  YES  NO If no, are you willing to commit to attend one of 4 available VIRTUS training sessions prior to CKC (contact church for more information)?  YES  NO  CONTACT INFORMATION:
Mobile Phone: _____________________________________ Email:_____________________________________________________  I am available to volunteer on the following days from 8:45 AM – 12:30 PM. Check ALL that apply. ________MON (6/15) _________TUES (6/16) _________WED (6/17) _________THURS (6/18) ________FRI (6/19)  I will utilize the onsite childcare for my children who are not old enough for camp (ages birth – 4). “Camp” T-‐shirts are available for the onsite childcare campers as well. Please pre-‐order below if you are interested. ONSITE CHILDCARE: CHILD NAME AGE TODDLER SIZE TSHIRT 2T 3T 4T  Order me a volunteer T-‐shirt (t-‐shirt cost is approximately $10, but will be finalized at a later date.) Note: Group Leaders will be required to order a T-‐shirt; it is preferred for all other volunteers CIRCLE ONE: PRE ORDER ONLY/NO PAYMENT DUE AT THIS TIME YOUTH SIZE ADULT SIZE L XL XS S M L XL XXL * ALL VOLUNTEERS MUST ATTEND A MANDATORY VOLUNTEER TRAINING ON TUESDAY, JUNE 9 AT SAINT CATHERINE AT 7 PM. MARK YOU CALENDAR NOW! {OVER} VOLUNTEER POSITIONS Please rank order your preferred volunteer position with 1 being your most desired position and 7 being your least desired or N/A position. Note that Group Leaders must be able to volunteer everyday. VOLUNTEER POSITION DESCRIPTION RANK GROUP LEADER M-‐F Consistent Position ONSITE CHILDCARE HELP CRAFT ROOM HELP SNACK ROOM HELP LESSON HELP M-‐F Consistent Position GENERAL RUNNER Youth Position Only SKIT PRODUCTION Ideal Youth Position FRIEND REQUEST Assigned to a group of ~20 campers and responsible for leading them from station to station. Group leaders will be asked to assist at the various station activities as needed. Ideally, group leaders are available to be at camp everyday and will stay with the same group for the duration of camp. PREFERRED AGE GROUP: We provide an onsite childcare nursery for the small children of those who are volunteering. This position is to assist in this onsite childcare nursery. Ages of the children to be cared for range from infant to 3 years old. Daily activities, crafts, and snacks are scheduled. A love of children and patience is required. Assist in the set up, assembly, and clean up of the daily craft. Ideally, craft volunteers are available everyday, but it is not a requirement Assist in preparation and serving of the daily snack. In addition to serving snack, there will be help needed with a coloring activity daily. Snack helpers must be at camp on their volunteer day NO LATER THAN 8:45 AM to begin preparations. This position does NOT require you to be there daily! Assist the lesson leader with any and all aspects of facilitating this station. Ideally, lesson helpers are available everyday to maintain consistency There are numerous “runner” jobs needed to make CKC run smoothly. Examples include assisting with daily service project collections and counting, running completed crafts to the mailboxes, delivering hospitality items to the station leaders, etc. This is a position for who are committed to helping make our camp a success. A skit will be performed each morning during the morning assembly. Volunteers who enjoy set creation and/or acting are encouraged to sign up to help with skit productions. This position is for MIDDLE and/or HIGH SCHOOL AGED VOLUNTEERS who are committed to a few advance preparation meetings. To the right, please list any friend requests. We will do our best to accommodate these requests, but they cannot be guaranteed. 1 – Most Desired 7 – Least Desired (or N/A) VOLUNTEER FRIEND REQUEST: