Summer Camp Registration

Which Camp Session Are You Registering For?*

We have four 4 week sessions and two 8 week sessions to choose from. Please make your selection below.

4 Weeks: Monday through Friday July 3rd to August 25th ($2,800)
4 Weeks: Monday, Wednesday, Friday July 3rd to Jul 28th ($1,800)
4 Weeks: Monday through Friday July 31st to July 28th ($2,800)
4 Weeks: Monday, Wednesday, Friday July 31st to August 25th ($1,800)
8 Weeks: Monday through Friday July 3rd to August 25th ($3,600)
8 Weeks: Monday, Wednesday, Friday July 3rd to August 25th ($3,000)

Have A Coupon Code?

Enter your coupon code here and hit apply to apply the savings.

Childs Name*

First Last

Home Address*

Street Address Address Line 2 City State ZIP Code

Gender:*

Child's Date of Birth*

Parent/Legal Guardian Name 1:*

First Last

Home Phone Number*

Cell Phone:*

Work Phone Number:*

Email Address:*

Enter Email Confirm Email

Parent/Legal Guardian Name 2:*

If this information is unavailable or does not apply please type N/A in each field to continue registration.

First Last

Home Phone:*

If this information does not apply, please enter the same information used for parent/guardian 1

Work Phone:*

If this information does not apply, please enter the same information used for parent/guardian 1

Cell Phone:*

If this information does not apply, please enter the same information used for parent/guardian 1

Email Address:

If this information does not apply, please enter the same information used for parent/guardian 1

Enter Email Confirm Email

Emergency Contact 1

Name*

First Last

Cell Phone:*

Work Phone*

Emergency Contact 2

Name*

First Last

Cell Phone:*

Work Phone*

Child's Medical Form Upload

Please upload your child's completed medical form by selecting choose file. If you prefer to email the form, you may send it to lmazzo@cc-si.org

Max. file size: 128 MB.

Consent*

By submitting and digitally signing this registration form I agree to the following:
-To have my child treated for any non-emergency situations
-To have my child participate in nature walks on the grounds of Mount Loretto and walks to and from the spray park on the property of Mount Loretto
-In case of an accident or injury, emergency medical care may be given in the event i cannot be reached
-My child will be released ONLY to the persons named above on this form

I Agree

Release of Liability*

I hereby give permission for my child/children to participate in the activities at Tender Care. I hereby exempt, release, and agree to hold harmless Tender Care, Catholic Charities of Staten Island, The Archdiocese of New York and their respective trustees, directors, officers, employees, servants and volunteers from an responsibility for any injury that may occur in connection with my child/children's participation, to the extent permitted by law.

I Agree

Signature*

By Digitally Signing this registration form I agree that all of the information provided is accurate and true. I also understand that I am agreeing to the terms and conditions, waiver of liability and selections for care I selected earlier in the application.

Printed Name of Signer:*

First Last

Total

$0.00

Credit Card

Card Details

Cardholder Name

Email Address Where We Will Send Receipt of This Transaction:*

Where should we send your registration receipt?

Summer Camp At Tender Care

Emergency Contact 1

Emergency Contact 2