SPX SUMMER CAMPS 2008 REGISTRATION

Name:	Age: Boy: Girl:
Child's School:	Rising Grade:
If SPX student, please list current homeroom teacher:
Address:
Home Phone:	Email:
Mother's Name:	Work #:
Father's Name:	Work #:
Mother's Cell #:
Father's Cell #:
PERMISSION/WAIVER If you would like your child to participate in this event, please complete, sign, and return the following statement of consent and release of liability. As a parent or legal guardian, I agree not to hold Saint Pius X School or SPX Summer Camp Staff responsible for injuries sustained by my child while participating in camp activities. I understand that in the event of an emergency, every effort will be made to contact me, my spouse, or the designated emergency contact person listed below. If I cannot be reached, I hereby give permission to SPX Camp Staff to secure proper medical treatment for my child. I carry medical insurance on my child and will provide SPX with that information if necessary. I understand that photos of my child may be used in next year’s summer camp booklet, on the SPX school website, and/or in camp advertisements.
Parent or Legal Guardian Signature (Type Name):
If parents/guardians are unable to be reached, we will contact the emergency contact listed below:
Emergency Contact (other than parent):
Phone Number:
Relationship:
SPX will need to administer medication to my child: Yes: No:
Allergies:
Other health concerns:

CAMP WEEKS

St. PIUS X CAMP ATTENDING
(List Name of Camp Below)

INSTRUCTOR
(Hendrix camps
require separate registration)

Week 1: June 9 - 13

Week 2: June 16 - 20

Week 3: June 23 - 27

Week 4: July 7 - 11

Week 5: July 14 - 18

Week 6: July 21 - 25

Week 7: July 28 - August 1

Week 8: August 4 - 8

Week 9: August 11 - 15

You do not need to register your child for Before/After Camp Care. It is available every camp day.

Would you like to be added to our summer camp mailing list?
Yes No

How did you hear about SPX Summer Camps?
Child is a student at SPX
Child is a former SPX Camper
Book at local retailer
Church;
Other;

ALL CAMPS are $135/week

1 camp @ $135
2 camps @ $270
3 camps @ $405
4 camps @ $540
5 camps @ $675
6 camps @ $810
7 camps @ $945
8 camps @ $1080
9 camps @ $1215

Separate registration form required for each child.
Total Number of SPX Camps Attending: Note: Camps by Master Hendrix are separate!
Total Amount Due: $
To pay using PayPal, select the camps from the Camp Schedule (add to cart), when finished, view cart and pay through PayPal
due May 30th ~ $35 late fee

Receipt Notification

I do not need a written receipt. I will use my cancelled check / PayPal receipt.
I require a written receipt.
fax to:
email to:

FREE T-SHIRT
Must register by May 2, 2008
Select One Size:
YS YM YL S M L XL XXL

2200 N. Elm Street
Greensboro, NC 27408

336-273-9865
fax: 336-273-0199

PERMISSION/WAIVER