CAMP REJOICE

CAMPER APPLICATION GENERAL INFORMATION

1) Complete one application per child and mail it to:
Camp Rejoice
P.O. Box 160298
Miami, Florida 33116
2) Pay online at camprejoice.org or mail in a check payable to CAMP REJOICE with your application
Circle Size for one FREE CAMP T-shirt: YOUTH 3-4 6-8 10-12 14-16 ADULT S M L XL
Childs Name _____________________________ Circle: Male / Female Age _______ Date of Birth _____________
Address _______________________________________ City __________________ Zip __________
Name of school ____________________________________ Grade completed ______________
Mothers name __________________ home # _____________ work # _____________ cell phone # _______________
Fathers name ___________________ home # _____________ work # _____________ cell phone # _______________
Parents e-mail address _________________________________ May we send text message reminders? Yes No
Emergency contacts
Name ______________________________ relation to child ___________________ phone #: _________________
Name ______________________________ relation to child ___________________ phone #: _________________
Name ______________________________ relation to child ___________________ phone #: _________________
Childs physicians name _____________________________ phone # _____________________
ARE THERE ANY special circumstances, allergies or medical conditions regarding your child of which the moderator
should be aware? If yes, please explain: ____________________________________________________________
____________________________________________________________________________________________
The following people are allowed to take my child home:
Name ______________________________ relation to child ___________________ phone #: _________________
Name ______________________________ relation to child ___________________ phone #: _________________
Name ______________________________ relation to child ___________________ phone #: _________________

PARENTAL AUTHORIZATION FIELD TRIP/ACTIVITY, SPORT RELEASE FORM, & MEDIA RELEASE
I hereby give my permission for my child to take part in all camp activities/outings and/or sports. I understand that campers may
be photographed or digitally videotaped during camp activities for use in Camp Rejoices promotional materials. In the event of
an emergency if I cannot be contacted, I hereby authorize that emergency treatment may be administered to my child. I hereby
release Camp Rejoice LLC., St. John Neumann Church and School, the Archdiocese of Miami or any of its employees from any
and all liability in case of accident or injury incurred during any camp activity, sport or camp sponsored field trip.
SIGNATURE OF PARENT OR GUARDIAN: X_________________________ DATE: _______________

CAMP REJOICE

CAMPER APPLICATION PAYMENT SHEET

**PLEASE ATTACH THIS WORKSHEET TO EACH OF YOUR PAYMENTS**

***ONE FORM PER CHILD***
CHILDS NAME: ______________________________________

CIRCLE WHAT YOUR

CURRENT PAYMENT
INCLUDES

Weekly
Camp Fee
Includes
Lunch
(9am4pm)

Early
Drop-Off
Program
Weekly
Fee
(7-8am)

After
Camp
Program
Weekly
Fee
(4-6pm)

Summer
Bridging
Tutorial
Program
Weekly
Fee
(4-6pm)

TOTALS:

Chk#/
CASH/
PayPal

Each camper must pay $50.00 ANNUAL registration fee

This includes ONE camp t-shirt $
PRE-PAY ALL 7 WEEKS OF CAMP AND WAIVE REGISTRATION FEE!
Week1

June 18- June 22

$125

$15

$25

$60

Week 2

June 25-June 29

$125

$15

$25

$60

Week 3

July 2- July 6

$125

$15

$25

$60

Week 4

July 9- July 13

$125

$15

$25

$60

Week 5

July 16- July 20

$125

$15

$25

$60

Week 6

July 23- July 27

$125

$15

$25

$60

Week 7

July 30- Aug 3

$125

$15

$25

$60

Circle size!!

Campers MUST wear camp t-shirt daily!

# of additional shirts: _____ x $8.00
YOUTH: 6-8 10-12 14-16
ADULT: S M L XL

Total included in this payment

Camp Fees may be paid in advance or may be paid weekly.

All weekly fees are due no later than Monday morning of each week.
Please make all payments on time to avoid a $10 late fee.
Make checks payable to: Camp Rejoice
Visit www.camprejoice.org to pay using pay pal. Attach confirmation of payment.

Parent Signature: _______________________

Camp Office Staff: ________________________