Summer Camp: Junior High Volunteer Registration

St. Matthew Summer Camp is offering a service hour program for rising 8th, 9th, and 10th graders. There are three goals of this program:

Earn volunteer service hours each week working with groups and activities at St. Matthew summer camp
Learn and practice leadership skills that can be used during camp as well as in future leadership roles in high school
Have fun and participate in age-appropriate summer activities during camp

Students can register for up to three weeks and spots will be filled in the service program based on availability and qualifications. All days for the volunteer service program runs from 8:30am - 3:30pm. More information will be sent to registrants in May. Camp director reserves the right to deny spots to registrants (full refunds will be given for those who do not get a spot).

The registration fee for this program is $75.00. Registration fee must be paid online with registration. Camp director will notify students and parents if spots fill for particular weeks. The deadline to submit registrations is May 31.

For the information regarding summer camp, visit https://www.smaschool.net/apps/pages/summercamp.

Junior High Volunteer

First Name*

Answer Required

Last Name*

Answer Required

Middle Name*

Answer Required

Student's Phone Number (Or parent's if student does not have a cell phone)*

Number Required

Email (If using school email, it must work externally during the summer)*

Answer Required

Current School Attending*

Answer Required

Date of Birth*

Answer Required

Weeks registering to volunteer for summer camp*

Choose up to three weeks

Answer Required

Week 1 (June 2 - 6)

Week 2 (June 9 - 13)

Week 3 (June 16 - 20)

Week 4 (June 23 - June 27)

Week 5 (July 7 - June 11)

Week 6 (July 14 - July 18)

T-Shirt Size (Each junior volunteer receives two t-shirts with registration. Extra shirts can be purchased at training.)*

Answer Required

Registration Questions

List all of your extra-curricular activities*

Answer Required

What other volunteers do you want to be paired with? What group would you like to work with?*

Answer Required

Describe your past volunteer or service experience*

Answer Required

Parent/Guardian Name 1

First Name*

Answer Required

Last Name*

Answer Required

Email*

Answer Required

Phone Number*

Number Required

Is your family parishioners of St. Matthew parish?*

Answer Required

Yes

Parent/Guardian Name 2

First Name

Answer Required

Last Name

Answer Required

Phone Number

Number Required

Release of Liability

RELEASE OF LIABILITY: I hereby consent to the participation by my child in the event described above and release my child to St. Matthew the Apostle's Catholic Church's care for St. Matthew Summer Camp. I acknowledge that there are certain risks associated with the activities, including, by way of example, physical injury due to activity, related accidents, and physical injury due to transportation related accidents. By signing this Liability/Waiver Form, I expressly assume all risks of the child participating in the activities, whether such risks are known or unknown to me at this time. I further release this organization and its leaders, employees, volunteers, and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child’s or my family or estate, heirs, representatives, or assigns may have against this organization or its leaders, employees, volunteers, or agents.

I further agree to indemnify and hold harmless this organization and its leaders, employees, volunteers, or agents from any and all claims arising as a result of injury or illness of my child during such activities.

Release of Liability*

Answer Required

Yes

Medical and Emergency Treatment

MEDICAL & EMERGENCY TREATMENT: I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of this organization to seek and secure any needed medical attention or treatment for the child named above including hospitalization, if in the agent’s opinion such need arises. In doing so I agree to pay all fees and costs arising from this action to obtain medical treatment. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery and, again, I agree to pay for the medical treatment. I give permission for the St. Matthew Camp Nurse and designated adult staff members to give over the counter medications as needed. I give permission to transport the child named above to a medical treatment center in a non-emergency vehicle in a medical emergency situation.

Medical and Emergency Treatment*

Answer Required

Yes

Media Publications

Enrolling a student into the St. Matthew the Apostle Summer Camp constitutes the consent of his parents/guardians for the student’s name, voice or likeness to be used in news publications, audio-visuals, and other electronic transmissions including the St. Matthew the Apostle website.

Media Publications*

Answer Required

Yes

Emergency Contact 1

First Name

Answer Required

Last Name

Answer Required

Relation to Camper

Answer Required

Phone Number

Number Required

List any information concerning your child's medical or physical condition (medications, allergies, ailments, etc.) that camp staff should know about. Attach additional info if necessary. If no conditions, please write NONE.

Answer Required

Medical File Upload (if necessary)

Answer Required

Choose a file or drag it here.

Insurance Information

Name of Provider

Answer Required

Provider's Address

Answer Required

Policy Holder's Name

Answer Required

Policy / Group Number

Answer Required

Physician Information

Name of Family Physician

Answer Required

Physician Phone Number

Number Required

Physician Address

Street Address

Answer Required

City

Answer Required

Zip/Postal

Answer Required

Signature*

Signature Required

Each Junior High Volunteer must pay a $75 registration fee. Fee must be paid after submitting the form.

Please fix the highlighted areas below before submitting.

Summer Camp: Junior High Volunteer Registration

Parent/Guardian Name 1

Parent/Guardian Name 2

Release of Liability

Medical and Emergency Treatment

Media Publications

Emergency Contact 1