Totus Tuus Registration Form

Camper's First & Last Name REQUIRED Please fill out this field. Please enter valid data.

Full Mailing Address (needed for tax receipt purposes) REQUIRED Please fill out this field. Please enter valid data.

Home Phone Number REQUIRED Please fill out this field. Please enter valid data.

Camper's Birth Date (Month, Day, Year) REQUIRED Please fill out this field. Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

School Attending REQUIRED Please fill out this field. Please enter valid data.

Grade Entering in Fall 2020 REQUIRED Please fill out this field. Please enter valid data.

Church Please enter valid data.

Please select the ONE camp week/site you wish to register for REQUIRED Please fill out this field.

Please check the camp you are registering for REQUIRED Day Camp (Grades 1-6) MONDAY - FRIDAY Evening Camp (Grades 7-12) SUNDAY - THURSDAY EVENING Please fill out this field.

How would you like to pay the camp registration fee (Please see our camp page on the website for detailed instructions on payment options) Internet E-transfer Cheque

Please check ths box if you would like to ADD on Extended Day Care until 4 pm (an additional $25 for the week per camper) Yes, I would like the extended day care option

Please indicate camper's t-shirt size (Youth Sizes for Day Camp, Adult Sizes for Evening Camp) REQUIRED Small Medium Large Extra-Large Please fill out this field.

Camper's Mother's Name Please enter valid data.

Mother's Email Please enter valid data.

Mother's Cell Phone Number Please enter valid data.

Camper's Father's Name Please enter valid data.

Father's Email Please enter valid data.

Father's Cell Phone Number Please enter valid data.

Emergency Contact (other than parents) Person who can be contacted to pick up camper if needed? REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.

Please list any medical information which may be helpful for us to be aware of (allergies, diabetes, asthma, etc.)

Is your child on any medications? Please indicate so below. All meds, except inhalers, must be turned into camp staff to be kept in secure location

Does your child have any unique learning needs or diagnosis that will impact his/ her participation in the program? Campers with high needs will require a parent / guardian to accompany them to camp.

I understand my son/daughter photograph and/or likeness and name may be used in a future promotion whether that be a parish publication, website, or camp video publication. REQUIRED Yes, I give consent for my child's photo to be used No, I do not consent for my child's photo to be used Please fill out this field.

In consideration of the acceptance of my children’s registration for the Totus Tuus Program and sponsorship by the Roman Catholic Archdiocese of Kingston, in Canada, including the Vocations Office and the Youth Ministry Office on behalf of myself, my heirs, assigns, executors and personal representatives, I release, hold harmless and forever discharge the Totus Tuus leaders, camp host parish, Staff, Caregivers and Volunteers, the Archdiocese of Kingston, its staff; officers, directors, employees and affiliates, from any and all liability, claims, losses, damages, costs or expenses, and waive any such claims against and such persons or organizations, arising directly or indirectly from, or attributable in connection with all Totus Tuus activities, both on host parish camp site and off site (park areas, school playground / green space) through the sponsorship and organization of the Archdiocese of Kingston. MEDICAL: I/we authorize and consent that emergency treatment be rendered under the general or specific supervision and on the advice of any physician, dentist, or surgeon; licensed to practice in the Province of Ontario. The undersigned understand(s) and agrees that any medical, dental, or hospital expense incurred shall be at their own expense. The undersigned understand(s) every effort will be made to notify the emergency contact in the event that treatment is necessary.

I have read the above and give consent for my child to participate in Totus Tuus 2020 Please select this field.

Name of Parent / Guardian completing and authorizing registration REQUIRED Please fill out this field. Please enter valid data.

Email that registration confirmation will be sent to. REQUIRED Please fill out this field. Please enter an email address.