Notre Dame Academy

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Notre Dame Academy Summer Camp
78 Howard Avenue
Staten Island, New York 10301
718-447-8878 ext. 250
 
Application and Consent Form
 
 
5 weeks: July 1st - August 2nd ~ 9:00am - 3:30pm Daily ~ Ages 5-12 years
For further information, please call: 718-447-8878 ext. 250
 

To secure a place at NDA camp, complete and submit the Application and Consent form with the $30.00 per child non-refundable Registration Fee (payable online via this form).
 
 
* Denotes a required field to fill in
How Many Children Are you Registering?*

Camper #1 Information


First and Last Name*
Age
Gender*
Grade in September 2019*
School Attending in September*

Camper # 2 (Sibling)


First and Last Name
Age
Gender
Grade in September 2019
School Attending in September

Camper # 3 (Sibling)


First and Last Name
Age
Gender
Grade in September 2019
School Attending in September

Camper # 4 (Sibling)


First and Last Name
Age
Gender
Grade in September 2019
School Attending in September

Parent #1 Information


First and Last Name*
Address*
Address Line 1 
Address Line 2 
City     State     Zip 
Home Phone*
Cell Phone*
Work Phone
Email*
Verify Email*

Parent #2 Information


First and Last Name
Address
Address Line 1 
Address Line 2 
City     State     Zip 
Cell Phone
Home Phone
Work Phone
Email Address

Week Selection

Please indicate weeks and number of children (if more than 1 child) who plan to attend Camp:


Week of July 1st

How many children will be attending the week of July 1st?
Will your child(ren) be attending the 5-Day Program or 3-Day Program?
If you selected the 3-Day Program, which days will your child(ren) be attending?
Monday, July 1st
Tuesday, July 2nd
Wednesday, July 3rd
Friday, July 5th
Will you be needing Early Arrival or Late Pick-Up?

Week of July 8th

How many children will be attending the week of July 8th?
Will your child(ren) be attending the 5-Day Program or 3-Day Program?
If you selected the 3-Day Program, which days will your child(ren) be attending?
Monday, July 8th
Tuesday, July 9th
Wednesday, July 10th
Thursday, July 11th
Friday, July 12th
Will you be needing Early Arrival or Late Pick-Up?

Week of July 15th

How many children will be attending the week of July 15th?
Will your child(ren) be attending the 5-Day Program or 3-Day Program?
If you selected the 3-Day Program, which days will your child(ren) be attending?
Monday, July 15th
Tuesday, July 16th
Wednesday, July 17th
Thursday, July 18th
Friday, July 19th
Will you be needing Early Arrival or Late Pick-Up?

Week of July 22nd

How many children will be attending the week of July 22nd?
Will your child(ren) be attending the 5-Day Program or 3-Day Program?
If you selected the 3-Day Program, which days will your child(ren) be attending?
Monday, July 22nd
Tuesday, July 23rd
Wednesday, July 24th
Thursday, July 25th
Friday, July 26th
Will you be needing Early Arrival or Late Pick-Up?

Week of July 29th

How many children will be attending the week of July 29th?
Will your child(ren) be attending the 5-Day Program or 3-Day Program?
If you selected the 3-Day Program, which days will your child(ren) be attending?
Monday, July 29th
Tuesday, July 30th
Wednesday, July 31st
Thursday, August 1st
Friday, August 2nd
Will you be needing Early Arrival or Late Pick-Up?

Informed Consent and Hold Harmless/Release Agreement

Waiver Acceptance Required
Please read and sign the below waiver.


Acceptance:* 
Full Name:* 
The following people are authorized to pick up my child(ren) after Camp. Please include their Name, Relationship to Child, and phone number.
Is there anyone who may NOT have access to your child(ren)?