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VBC Camper Registration

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  Parent Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Secondary Phone Number Please enter valid data.
  
  Home Address REQUIRED Please fill out this field. Please enter valid data.
  
  By checking the box below, I authorize my child(ren) to participate in all camp activities and permit Divine Redeemer Parish to use their discretion should any medical treatment be necessary for my child(ren). I will not hold Divine Redeemer Parish or the Roman Catholic Diocese of Pittsburgh responsible for the payment of any medical or injury-related costs.
  
  Emergency Treatment Consent REQUIRED I agree Please fill out this field.
  
  May we share photos of your child in the bulletin/on social media? REQUIRED Yes, my child(ren)'s photos may be published No, please do NOT publish photos of my child(ren) Please fill out this field.
  
  Payment . . . REQUIRED
  Select the option that best meets your needs
  35.0 – $35 per child OR . . . 0.0 – I'm an Adult Volunteer OR . . . 0.0 – I'd like to explore financial assistance (or pay later) Please fill out this field.
  
  How many children would you like to register? REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age/Fall 2025 Grade REQUIRED Please fill out this field.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Please list any allergies, dietary needs, or special needs. If your child carries an EpiPen, please let us know.
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age/Fall 2025 Grade REQUIRED Please fill out this field.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Please list any allergies, dietary needs, or special needs. If your child carries an EpiPen, please let us know.
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age/Fall 2025 Grade REQUIRED Please fill out this field.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Please list any allergies, dietary needs, or special needs. If your child carries an EpiPen, please let us know.
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age/Fall 2025 Grade REQUIRED Please fill out this field.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Please list any allergies, dietary needs, or special needs. If your child carries an EpiPen, please let us know.
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Age/Fall 2025 Grade REQUIRED Please fill out this field.
  
  T Shirt Size REQUIRED Please fill out this field.
  
  Please list any allergies, dietary needs, or special needs. If your child carries an EpiPen, please let us know.
  
  Total:
  
  Submit
  
  Proceed to Payment
  
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