Summer Programs Registration

Name of Camper/s
Grade as of Fall 2014
T-Shirt Size (Adult only)
SmallMedium
LargeXL
XXL
Street Address or P.O. Box
City
State
ZIP
Home Phone
Emergency Phone
School
School Address
Parent/Guardian
Email
Parent/Guardian Authorization
I hereby approve of my child’s attendance to Summer at Benedictine and certify that he/she is in good health and able to participate in the program. I authorize that the director act for me according to his best judgment in any emergency requiring medical attention. I understand, should an emergency condition arise, I will be contacted during the physical exam. If I am not available, I authorize you to contact:
Confirm Approval - This will serve as your electronic signature
Yes
Name of Physician
Health Insurance Carrier
Policy #
Basketball camp is $225. Football Day Camp is 35$ Wrestling is $120 All other camps are $190 There are discounts for multiple camp purchases. No refunds. Campers will need to provide their own lunch and transportation.
I will attend:
Outdoor AdventureBasketballWrestlingRobotics
Football Day Camp
If attending a camp with more than one session, indicate which you prefer.

Online Camp Payment
Please enter number of camps attending in the boxes below, e.g., "1 @ $190"
One Camp - See below for Basketball  @ $190.00
Two Camps(10% Off)  @ $361.00
Three Camps(15% Off)  @ $522.00
Group of Ten(10% Off each camper)  @ $1,710.00
Wrestling ONLY  @ $120.00
Basketball Camp ONLY  @ $225.00
2 Basketball Camps ONLY  @ $405.00
3 Basketball Camps ONLY  @ $607.50
Group of Ten BASKETBALL Campers(10% Off each camper)  @ $2,025.00
Football Day Camp  @ $35.00
Form Total: $0.00
Name on Card*
Credit Card Type*
Card Number*
Expiration Month*
Expiration Year*
CCV*
Questions/Comments?
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