Camper Name (First & Last)       

Gender    Male     Female

Grammar School                                 

Camper Grade for 2008-2009 School Year   4th 5th 6th 7th 8th

Parent/Guardian Name (First & Last)    

Parent/Guardian E-mail Address          

Emergency Contact Number                 

Street Address                                      

City         State            Zip Code      
          
                                   
**All Fields Must Be Complete To Ensure Registration.

**Full Payment is Due on the 1st Day of Camp or Mail Payment to:

St. Rita of Cascia High School
Summer Camps
7740 S. Western Ave, Chicago, IL 606020

Parent/Guardian must sign this statement when dropping off camper on the 1st day of camp. I hereby authorize the staff of the St. Rita Band Camp to act for me according to their best judgment in any emergency requiring medical attention for my child, and I hereby waive and release the camp from any and all liability for injury or illness incurred during the week.