Summer Camp Registration Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Welcome to the 2024 St. Athanasios Summer Camp Registration Families should be in good standing with their respective parish. If you are a parishioner of St. Athanasios, please click click here to pay minimum stewardship of $500 for 2024 if you have not already. Registration Fee of $240 per child plus $10 credit card fee per child must be paid online only using this form. Parent/Guardian Primary Contact InformationGuardian's Name *FirstLastLayoutGuardian's Email *Guardian's Phone *Billing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeResidence is same as Billing Address (if not, uncheck this:)YesResidence AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNumber of Children Registering Selected Value: 1 NextChild 1 InformationName *FirstLastEmailDate of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade entering for 2024-2025 (American School) *Pre-KK123456789101112Tshirt Size *Y-SmallY-MediumY-LargeY-Extra LargeA-SmallA-MediumA-LargeA-Extra LargeDoes the child require regular medication? *noyesPlease specify mediation *AllergiesHay FeverAsthmaInsects/BeesPoison Ivy/OakFoods (specify)Medication (specify)Specify allergy details (if any):Chronic IllnessEar InfectionsHeart DiseaseConvulsions/SeizuresDiabetesFaintingChild 2 InformationName (2) *FirstLastEmail (2)Date of Birth (2) *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade entering for 2024-2025 (American School) (2) *Pre-KK123456789101112T-shirt Size (2) *Y-SmallY-MediumY-LargeY-Extra LargeA-SmallA-MediumA-LargeA-Extra LargeDoes the child require regular medication? (2) *noyesPlease specify medication (2) *Allergies (2)Hay FeverAsthmaInsects/BeesPoison Ivy/OakFoods (specify)Medication (specify)Specify allergy details (if any): (2)Chronic Illness (2)Ear InfectionsHeart DiseaseConvulsions/SeizuresDiabetesFaintingChild 3 InformationName (3) *FirstLastEmail (3)Date of Birth (3) *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade entering for 2024-2025 (American School) (3) *Pre-KK123456789101112T-shirt Size (3) *Y-SmallY-MediumY-LargeY-Extra LargeA-SmallA-MediumA-LargeA-Extra LargeDoes the child require regular medication? (3) *noyesPlease specify medication (3) *Allergies (3)Hay FeverAsthmaInsects/BeesPoison Ivy/OakFoods (specify)Medication (specify)Specify allergy details (if any): (3)Chronic Illness (3)Ear InfectionsHeart DiseaseConvulsions/SeizuresDiabetesFaintingChild 4 InformationName (4) *FirstLastEmail (4)Date of Birth (4) *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Grade entering for 2024-2025 (American School) (4) *Pre-KK123456789101112T-shirt Size (4) *Y-SmallY-MediumY-LargeY-Extra LargeA-SmallA-MediumA-LargeA-Extra LargeDoes the child require regular medication? (4) *noyesPlease specify medication (4) *Allergies (4)Hay FeverAsthmaInsects/BeesPoison Ivy/OakFoods (specify)Medication (specify)Specify allergy details (if any): (4)Chronic Illness (4)Ear InfectionsHeart DiseaseConvulsions/SeizuresDiabetesFaintingPreviousNextFamily PhysicianFamily Physician NameFamily Physician PhoneEmergency ContactEmergency Contact Name *FirstLastEmergency Contact Phone *Notice Regarding Severe Allergies Please inform the councelors of any severe condititions and provide necessary medication or Epipens. Authorization for Medical Treatment (sign here)Clear SignatureIn the event that I can not be reached, I give permission for the adult in charge to take my child to a qualified licensed physician or to a nearby hospital for necessary treatment.Consent for photographs and videos to be shared on web or social media?YesNoNextPay & Checkout2024 Summer Camp Registration Reminder Families should be in good standing with their respective parish. If you are a parishioner of St. Athanasios, please click click here to pay minimum stewardship of $500 for 2024 if you have not already. Registration Fee of $240 per child plus $10 credit card processing fee per child must be paid online only using this form. Total Number of Children for Summer Camp *1 Child - $250.002 Children - $500.003 Children - $750.004 Children - $1,000.00Square *CardName on CardSubmit