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This form serves as registration for both campers and crew. If your students have different emergency information, please email kristie.manning@dsj.org with the specifics for each child.
Name of Parent or Guardian(s) REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Name of Emergency Contact (other than parent) REQUIRED Please fill out this field. Please enter valid data.
Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.
Student's Name (First, last) REQUIRED Please fill out this field. Please enter valid data.
Student's Grade in Fall of 2023 REQUIRED Please fill out this field. Please enter valid data.
(child's name) has the following physical limitations or allergies: Please enter valid data.
Student's Name (First, last) Please enter valid data.
Student's Grade in Fall of 2023 Please enter valid data.
(child's name) has the following physical limitations or allergies: Please enter valid data.
Student's Name (First, last) Please enter valid data.
Student's Grade in Fall of 2023 Please enter valid data.
(child's name) has the following physical limitations or allergies: Please enter valid data.
Student's Name (First, last) Please enter valid data.
Student's Grade in Fall of 2023 Please enter valid data.
(child's name) has the following physical limitations or allergies: Please enter valid data.
Shirt Size (check all that apply) REQUIRED Youth Small Youth Medium Youth Large Youth XL Small Medium Large XL 2XL Please fill out this field.
PHOTO RELEASE
I hereby give Queen of Apostles Parish permission to use photographs taken during Faith Formation classes, events, and children’s liturgies of my child(ren) in all forms and media, and in all matters including composite representation for lawful purposes.

No student’s personal identifiers will be used. I waive my right to inspect or approve the finished version(s), including written copy that may be created in connection therewith.
I Agree Please select this field.
DSJ WAIVER

TO THE EXTENT PERMITTED BY LAW, I HOLD THE PARISH/SCHOOL AND DIOCESE OF SAN JOSE HARMLESS FROM ANY CLAIM OF INJURY, SICKNESS, ILLNESS OR DAMAGE THAT I /MY CHILD MAY SUFFER OR SUSTAIN DURING THE PROGRAM LISTED ABOVE, WITH EXCEPTION TO INJURY OF DAMAGES ARISING OUT OF THE SOLE NEGLIGENCE OF THE PARISH/SCHOOL OR DIOCESE OF SAN JOSE. I ATTEST THAT I AM/MY CHILD IS PHYSICALLY FIT TO PARTICIPATE IN THIS PROGRAM.
IN THE EVENT THAT I/MY CHILD BECOME(S) ILL OR INJURED, I DO HEREBY CONSENT TO WHATEVER MEDICAL TREATMENT(S), INCLUDING BUT NOT LIMITED TO X-RAY, EXAMINATION, OR HOSPITAL CARE, CONSIDERED NECESSARY IN THE BEST JUDGEMENT OF THE ATTENDING PHYSICIAN AND PERFORMED BY OR UNDER THE SUPERVISION OF A MEMBER OF THE MEDICAL STAFF OF THE HOSPITAL AND/OR OTHER MEDICAL FACILITY PROVIDING THE TREATMENT. I AM NOT AWARE OF ANY MEDICAL CONDITION WHICH WOULD RENDER IT INAPPROPRIATE FOR ME/MY CHILD TO PARTICIPATE IN ANY ACTIVITY ASSOCIATED WITH THE PROGRAM.

I Agree Please select this field.
IN THE EVENT OF A MEDICAL EMERGENCY, if I cannot be contacted, I give Queen of Apostles Family Faith Formation Program permission to obtain suitable medical assistance for my child.
I Agree Please select this field.

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