WhenJune 26-30 each day from 9:00 am – 12:00 pm WhereMusic RoomIn the church basement We will sing at Mass on Sunday, July 2, however participation there is not required for attending the camp. Parent/Guardian Name(Required) First Last Family Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Email(Required) Best Phone(Required)Alternate PhoneMay we text you?(Required) Yes No How many children are you registering?123Name (child 1)(Required) First Last Grade Entering (Fall '23)(Required)2nd3rd4th5thAny Allergies? (child 1) Child 2Name (child 2)(Required) First Last Grade Entering (Fall '23)(Required)2nd3rd4th5thAny Allergies? (child 2) Child 3Name (child 3)(Required) First Last Grade Entering (Fall '23)(Required)2nd3rd4th5thAny Allergies? (child 3) Emergency Contact(Required) First Last Different than parent nameEmergency Contact Phone(Required)Medical Waiver(Required) I agree to the terms and conditions of the medical waiver.If the parents or guardians cannot be contacted in case of serious injury or illness, I authorize St. James Staff to take emergency action deemed necessary, including the transportation of the student to a hospital or medical center. As a parent or guardian, I authorize the treatment by a qualified and licensed medical doctor of the minor(s) listed in this registration in the event of a medical emergency that, in the opinion of the attending physician, may endanger his/her life, cause disfigurement or undue discomfort if delayed. This authority is granted only after a reasonable effort has been made to reach me.Photo/Media Waiver I agree to the terms and conditions of the photo/media waiver.I hereby authorize and give my full consent to St. James Parish the use of my child(ren)’s image (photographs, video, and/or audio) and further agree that St. Jams Parish may use these photographs, video or audio files for promotional materials.Liability Waiver(Required) I agree to the terms and conditions of the liability waiver.I hereby give permission to my son/daughter, mentioned above, to participate in activities sponsored by St. James. I hereby release and indemnify the Archdiocese of Chicago, St. James for this event, its staff and volunteers; and the Catholic Bishop of Chicago, a corporation sole, from any and all liability arising from claims of any kind or nature whatsoever from my child’s participation in the program. I understand that if my child violates any laws regarding possession of alcohol or drugs, or rules governing the event, I will be called and notified about situation and/or arrangements made to send my child home at my expense.PaymentPlease select the number of children you're registering(Required)1 Child2 Children3 ChildrenTotal Payment Method*Credit Card American ExpressMasterCardVisaSupported Credit Cards: American Express, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name