(MAIDENS) REGISTRATION PAGE | ThreeHeartsPilgrimag

ST. SCHOLASTICA'S MAIDENS CAMP
SUMMER 2023

JUNE 25TH - 30TH | FORT SCOTT, KANSAS

CAMPER'S FIRST NAME

CAMPER'S LAST NAME

Phone Number

Camper DOB

Street Address

Street Address Line 2

City

Postal / Zip code

Region/State/Province

Mother First Name

Mother Last Name

Cell Phone Number

Father First Name

Father Last Name

Cell Phone Number

Second Camper: First Name

Name of Health Insurance Provider

First & Last Name of Policy Holder:

Second Camper: Last Name

Second Camper DOB

Insurance ID Number:

Group Number

Upload Insurance Card

Front & Back Images

I AGREE TO ABIDE BY THE MAIDEN RETREAT'S BEHAVIOR POLICIES ( Parents and Daughters read together )Maiden's Retreat Camper Policies

I understand my daughter may be photographed/video during camp activities. I agree that images may be used for educational and public relations purposes by The St. Scholastica's Summer Camp.

I certify that my daughter meets the Physical Fitness Terms to ParticpateView terms

PARENT SIGNATURE

CAMPER 1 SIGNATURE

CAMPER 2 SIGNATURE (If applicable)

PILGRIMAGE

THREE HEARTS

ST. SCHOLASTICA'S MAIDENS CAMP
SUMMER 2023

JUNE 25TH - 30TH | FORT SCOTT, KANSAS

ORGANIZATION INFO

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PILGRIMAGE

ST. SCHOLASTICA'S MAIDENS CAMP SUMMER 2023

JUNE 25TH - 30TH | FORT SCOTT, KANSAS

ORGANIZATION INFO

TOOLS FOR PILGRIMS

SUPPORT THE PILGRIMS

ST. SCHOLASTICA'S MAIDENS CAMP
SUMMER 2023