Camper Registration

St. John Vianney
Mercy Camp
Camper Registration

June 24-28, 2019

Registration Fee: $ 150
Please bring payment to Parish Office
or
Faith Direct with a One Time Gift to Mercy Camp

Camper's Full Name: REQUIRED Please fill out this field. Please enter valid data.

Camper's Mailing Address: REQUIRED Please fill out this field.

Camper's School Grade for Fall 2019: REQUIRED Please fill out this field. Please enter valid data.

Camper's Birthdate: Please enter valid data.

Camper's Gender: Male Female

Camper's Primary Language: REQUIRED Please fill out this field. Please enter valid data.

Camper's Shirt Size (adult sizes): XS S M L XL

Does the camper have a school: REQUIRED IEP LEP SLP 504 Other Plan Not Listed Physical Disability None Please fill out this field.

Primary Parent/Gaurdian Full Name: REQUIRED Please fill out this field. Please enter valid data.

Primary Parent/Gaurdian Phone Number: REQUIRED Please fill out this field. Please enter valid data.

Primary Parent/Gaurdian Email: REQUIRED Please fill out this field. Please enter valid data.

Secondary Parent/Gaurdian Full Name: REQUIRED Please fill out this field. Please enter valid data.

Secondary Parent/Gaurdian Phone Number: REQUIRED Please fill out this field. Please enter valid data.

Secondary Parent/Gaurdian Email: REQUIRED Please fill out this field. Please enter valid data.

Please check the days one of the Parent/Gaurdians listed above would be available to volunteer: REQUIRED Monday Morning Monday Afternoon Tuesday Morning Tuesday Afternoon Wednesday Morning Wednesday Afternoon Thursday Morning Thursday Afternoon Friday ALL DAY Please fill out this field.

Are you available to drive on the days you volunteer? Yes No

St. John Vianney Church

Prince Frederick, MD

Camper Registration

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