Camp ASB Registration Form 2024

Registration Form 2024

In the event of an emergency, or if your child becomes ill at Camp ASB, it is imperative we have up-to-date information so that you can be notified and arrangements can be made. Parents/guardians will be called first, and only if they cannot be reached will other steps be taken.

Student Information

Please register each student individually.

Student Last Name*

Answer Required

Student First Name*

Answer Required

Grade for 2024-2025 school year*

Answer Required

Home Address*

Answer Required

Allergies, Medical, or Special Needs

Answer Required

Parent/Guardian 1 Information

Last Name*

Answer Required

First Name*

Answer Required

Email Address*

Answer Required

Phone Number*

Number Required

Alternate Phone Number

Number Required

Parent/Guardian 2 Information

Last Name*

Answer Required

First Name

Answer Required

Email Address

Answer Required

Phone Number

Number Required

Alternate Phone Number

Number Required

Authorizations

Additional people who may pick up your child:*

Answer Required

I hereby give permission for my child to receive the following at Extended Care when necessary:*

Answer Required

Benadryl

Ibuprofen

Tylenol

Family provided medicine with instructions

None

The staff of Assumption-St. Bridget's Camp ASB will take the steps indicated in case of injury or illness to my child.*

Answer Required

I hereby authorize

Emergency Contacts

Used in case you cannot be reached. These contacts may also be called if Camp ASB is closed and a parent/guardian has yet to pick up your child(ren).

Emergency Contact 1 Full Name*

Answer Required

Emergency Contact 1 Phone Number*

Answer Required

Emergency Contact 2 Full Name*

Answer Required

Emergency Contact 2 Phone Number *

Number Required

Rates & Billing Information

Registration fee: $65 (1 paid per family)
Hourly: $15 an hour
Prepaid June: $700
Prepaid August: $1500
Prepaid FULL SUMMER- $2000 (registration fee will be waived)

If a family is planning on using Camp ASB for five hours a day or more, the prepayment options will save money.

Please indicate which payment option you are selecting for Camp ASB 2024. Charges for Camp ASB will be added to FACTS after confirmation with each family. If prepaying for weeks or sessions, those charges will be added the Friday before the prepaid week.*

Answer Required

Hourly drop-in, $15 an hour

June prepayment, $700

August prepayment, $1500

Camp ASB full summer prepayment, $2000

Parent/Guardian Signature*

Answer Required

Please fix the highlighted areas below before submitting.

Camp ASB Registration Form 2024

Registration Form 2024