Camper Registration

St. John Vianney
Mercy Camp
Camper Registration

Date to Be Announced

Registration Fee: $ 100
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 Wednesday Thursday Friday Please fill out this field.

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