Summer Camp Registration Simply use the form below to register for our upcoming camp. Registration is due no later than May 15th Summer Camp At Tender Care 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Gender:*BoyGirlChild's Date of Birth* MM slash DD slash YYYY 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 1Work Phone:*If this information does not apply, please enter the same information used for parent/guardian 1Cell Phone:*If this information does not apply, please enter the same information used for parent/guardian 1Email Address:If this information does not apply, please enter the same information used for parent/guardian 1 Enter Email Confirm Email Emergency Contact 1Name* First Last Cell Phone:*Work Phone*Emergency Contact 2Name* First Last Cell Phone:*Work Phone*Child's Medical Form UploadPlease upload your child's completed medical form by selecting choose file. If you prefer to email the form, you may send it to firstname.lastname@example.orgMax. 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 AgreeRelease 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 AgreeSignature*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 CardCard Details Cardholder Name Email Address Where We Will Send Receipt of This Transaction:*Where should we send your registration receipt?