Little Saints Summer Camp

Please complete one form for each child attending camp.

Camper First Name REQUIRED Please fill out this field. Please enter valid data.

Camper Last Name REQUIRED Please fill out this field. Please enter valid data.

Camper Address REQUIRED Please fill out this field. Please enter valid data.

Camper Birthday REQUIRED Please fill out this field. Please enter valid data.

Is your child currently enrolled at PJPII? REQUIRED

No

Yes No Please fill out this field.

Grade Entering for the 2026-2027 School Year REQUIRED PK3 PK4 K Please fill out this field.

Week 1-June 8-June 12 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 2-June 15-June 19 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 3-June 22-June 26 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 4-June 29 -July 2***CLOSED JULY 3 Monday Tuesday Wednesday Thursday Half-Days (12:30 pick-up) Full Days

Week 5-July 6-July 10 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 6-July 13-July 17 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 7-July 20-July 24 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 8-July 27-July 31 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

Week 9-August 3-August 7 Monday Tuesday Wednesday Thursday Friday Half-Days (12:30 pick-up) Full Days

If full day schedule selected, please list approximate drop off and pick up times REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Name #1 REQUIRED Please fill out this field. Please enter valid data.

Parent/ Guardian #1 Phone Number REQUIRED Please fill out this field. Please enter valid data.

Parent/ Guardian #1 Email Address REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Name #2 REQUIRED Please fill out this field. Please enter valid data.

Parent/ Guardian #2 Phone Number REQUIRED Please fill out this field. Please enter valid data.

Parent/ Guardian #2 Email Address REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact #1, name, address, and phone number REQUIRED

Please list name, relationship, phone #. Example: Mary Smith, grandmother, 555-555-5555

Please fill out this field.

Emergency Contact #2, name, address, and phone number REQUIRED

Please list name, relationship, phone #. Example: Mary Smith, grandmother, 555-555-5555

Please fill out this field.

Medical Information REQUIRED

Does your child suffer from any allergies, illness or other medical condition? If yes, please detail below.

Please fill out this field.

Has your child ever been stung by a bee or wasp? REQUIRED

No

Yes No Please fill out this field.

Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Policy Number REQUIRED Please fill out this field. Please enter valid data.

Preferred Hospital REQUIRED

Please note that during an emergency, emergency dispatch may not allow for a choice in hospital.

Please fill out this field. Please enter valid data.

Authorized Pickup Person #1, Name, Address, Phone REQUIRED

Please list who can and cannot pick up your child (ren)

Please fill out this field.

Authorized Pickup Person #2, Name, Address, Phone REQUIRED

Please list who can and cannot pick up your child (ren)

Please fill out this field.

MEDICAL RELEASE

In a medical emergency, I/we hereby authorize the camp/school representative to obtain or administer minor first aid, emergency care, or to seek emergency medical assistance and transport our child to hospital if needed and we cannot be reached. I/We also authorize, if circumstances require, the emergency department physician, family physician, or school physician to provide initial examination and treatment.

Medical Release REQUIRED I/We Agree Please fill out this field.

PHOTOGRAPH RELEASE

Parent/Legal Guardian of the children listed on the registration form hereby give the Archdiocese of Philadelphia, its successors and assigns and those acting with its authority, the unqualified right and permission to reproduce, copyright, publish, circulate or otherwise use any school pictures and video of my child produced by the Archdiocese of Philadelphia and Pope John Paul II RCES & Summer Programs. This authorization and release covers the use of said camp pictures and video in any published form, including but not limited to newsletters, websites, social media, and any other media of advertising publicity. I also understand that our school may be identified by name and I fully understand that this is a complete release of all claims against the Archdiocese of Philadelphia or any other person, firm or corporation by reason of any such use of such school pictures. I hereby warrant that I am free to give this permission. I also understand that Pope John Paul II RCES & Summer Programs cannot be held responsible for photographs/video recordings taken by other parents during open performances.

Photo Release REQUIRED Yes No Please fill out this field.

Charge Account for Camp Fees (NOT including registration fee) REQUIRED Yes Please fill out this field.

CAMP PARTICIPATION AGREEMENT AND RELEASE
We (I), Parent/Legal Guardian of the child(ren) listed on the registration form
give permission for the child(ren) to participate in the Summer Programs to which includes all related programs or events. In consideration for our (my) son’s/daughter’s participation and intending to be legally bound, we (I) and our (my) son/daughter agree and understand that we assume risk in full for our (my) son’s/daughter’s participation in the Summer Programs and with full knowledge of the risk inherent in such an activity, we release and hold harmless Pope John Paul II Regional Catholic Elementary School, affiliated parishes, the Archdiocese of Philadelphia, and its priests, religious, teachers, aides, employees, agents, administrators, and any official representatives, from any and all liability, damages, or claims for any and all personal injury, bodily injury, and/or property damage arising or related to our (my) son’s/daughter’s participation. We (I) and our (my) son/daughter understand and agree to abide by all rules and regulations established by Pope John Paul II Regional Catholic Elementary School pertaining to the Summer Programs and school code of conduct.

Camp Participation Agreement REQUIRED I/We Agree Please fill out this field.

LSA Summer Camp registration fee25.0

POPE JOHN PAUL II REGIONAL
CATHOLIC ELEMENTARY SCHOOL

2875 Manor Road
West Brandywine, PA 19320

Office-610.384.5961

Proudly accredited until 2033!

Little Saints Summer Camp

Camp Information