The Office of Vocations, Diocese of Bridgeport AND St. John Fisher Seminary Residence
Summer Camps

2008 Diocese of Bridgeport
Summer Camp Registration Form
Please fill out one form for each camper.
*Required Fields

Registration Deadline: June 13, 2008

PERSONAL INFORMATION
Camper Name*:
Street Address*:
City*:  
State*:   
Zip*:  
Parent/Guardian Name*:
Camper Date of Birth*: mm/dd/yyyy
Camper Age*:
Home Phone*: xxx-xxx-xxxx
Work Phone: xxx-xxx-xxxx
Cell Phone: xxx-xxx-xxxx
Email*:
Parish: (incl. town)

How did you hear about the Camp?

T-Shirt Size*:
           

CAMP SELECTION
Please select the camp you are registering for*:

Quo Vadis Days BOYS Camp   OR   Sequela Christi Days GIRLS Camp
       June 29 - July 3, 2008                          June 23 - 27, 2008

Both camps will take place at the Seton-Neuman Center which is located at Immaculate High School in Danbury, CT.

PERMISSION
* (name of camper) has my permission to participate in the camp as selected above being conducted by theDiocese of Bridgeport Office of Vocations with Rev. Peter J. Lynch, Director of Vocations, or any priest, chaperone or other licensed driver associated with him. I understand that neither St. John Fisher Seminary nor the Diocese of Bridgeport nor any of its agents are responsible for any injury sustained by my child. I accept responsibility for any medical expenses as a result of any such injury sustained.

I do herewith authorize the treatment by a qualified and licensed medical doctor of my child in the event of a medical emergency which, in the opinion of the attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed.  This authority is granted only after a reasonable effort has been made to reach me. This release is intended for the camp I have selected above. This form is completed and signed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances in my absence.

MEDICAL INFORMATION - * Required for Registration *
Date of Last Tetanus Shot:  * MM/DD/YYYY

Specific medical allergies, chronic illnesses or other conditions:

Family Physician:  *     Phone:  *

Another person to contact in the case of emergency:
Name:  *     Phone:  *

Any other comments, questions or concerns?

Check here if you do not give permission to use photos of your child in promotional materials.

PAYMENT
After you submit this form electronically, please mail the $25 registration fee per camper, made out to: Office of Vocations

Please mail check to: Office of Vocations, St. John Fisher Seminary, 894 Newfield Avenue, Stamford, CT 06905.

If financial assistance is needed, please call 203-322-5331.

ALL information requested above must be completed before submitting form, especially all medical information.