TSMSOC Throwback Summer Camp Signup - St.Michael School of Clayton

Camp Registration Information

Child's First Name

Child's Birth Date

Child's Last Name

Child's Age

As of May 1st, 2022

Current School

Grade Entering in Fall 2022

Gender

Please Select Sessions

Session 1: June 6 - June 17, 2022

Session 2: June 20 - July 1, 2022

Session 3: July 5 - July 15, 2022

Session 4: July 18 - July 29, 2022

$650 per session / TSMSOC Students $625 per session

TSMSOC Student?

Yes

No

Register for before or aftercare

Yes

No

Camp T-Shirt

YXS

YS

YM

YL

AS

AM

AL

AXL

$15 will be added to your total for a camp t-shirt

Allergies

Yes

No

Medications

Yes

No

Other Impaired Health Issues

Yes

No

Parent / Safety Concerns / Other Notes

Enroll Second Child

Yes

No

Parent / Guardian First Name

Parent / Guardian Last Name

Address

City

State

Zip Code

Cell Phone

Home Phone

Work Phone

Email

Parent / Guardian First Name

Parent / Guardian Last Name

Same Address as Above Parent

Yes

No

Cell Phone

Home Phone

Work Phone

Email

Pediatrician's Name

Pediatrician's Phone Number

Emergency Contact's Name

Enter First and Last Name

Home Phone

Cell Phone

Work Phone

Enter Second Emergency Contact

Yes

No

Photo Release Agreement

Yes

No

Yes, I authorize The St. Michael School to permit the video/ photographing of my child and to use such video/ photographs in its publications.

Medical Emergency Agreement

Yes

No

I do hereby grant permission for The St. Michael School to secure such medical and/ or hospital services as deemed necessary for my child in the event he/ she should sustain an injury or illness while a ending camp or a camp-sponsored field trip. I have also indicated below any medical information of which the school should be aware in consideration of my child's physical and mental well-being.

Camp T-Shirt(s)

Total:

Total

Total:

Total:

Total:

Phone

(314) 721-4422

Connect

Address

6345 Wydown Blvd, St. Louis, MO 63105

School Hours

8:00am - 3:45pm