Day Camp Registration | Jesuit High School of New Orleans

Campers

Camper Name	Actions

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Number of Campers(Required)

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Cost Per Week

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Registration Fee(Required)

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Date

The base cost per week of day camp is $200.00 per camper. Discounts are available for registrants who select a complete session (15%) or both sessions (an additional 5% off). Discounts are also available when more than one camper is registered at a time (10%, 15%, and 20% successively for 2, 3, and 4 campers). A non-refundable $50.00 registration fee applies to the entire registration.

Late Registration Fee

Price:

Non-Refundable Registration Fee(Required)

Applies once to entire registration.

Price: $50.00

Session 1

Week 1: May 30 - Jun. 2

Week 2: Jun 5 - 9

Week 3: Jun 12 - 16

Session 2

Week 4: Jun 19 -23

Week 5: Jun 26 - 30

Week 6: Jul 3 - 7

Week 1

Price: $170.00

Week 2

Price: $170.00

Week 3

Price: $170.00

Week 4

Price: $170.00

Week 5

Price: $170.00

Week 6

Price: $170.00

Discounts

Any discounts that apply to your registration will appear here.

Complete Session 1 Discount

15% off Session 1

$0.00

Complete Session 2 Discount

15% off Session 2

$0.00

Complete Summer Discount

Additional 10% off Both Sessions

$0.00

Two Camper Discount

10%

$0.00

Three Camper Discount

15%

$0.00

Four Camper Discount

20%

$0.00

Subtotal & Total

Coupon

If you have a coupon code, please enter it here.

Subtotal

Before discounts

$0.00

Total

With discounts applied

Camper Home Details

Camper Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1

Parent/Guardian/Emergency 1 (Primary Contact)(Required)

First name Last name

Email (Primary Contact)(Required)

Day Phone (Primary Contact)(Required)

Cell Phone (Primary Contact)(Required)

Parent/Guardian 2

Parent/Guardian/Emergency 2 (Secondary Contact)(Required)

First name Last name

Day Phone (Secondary Contact)(Required)

Cell Phone (Secondary Contact)(Required)

Email (Secondary Contact)(Required)

Medical Information

Medical Insurance Provider(Required)

Policy Holder's Name(Required)

Group/Policy Number(Required)

Provider's Address(Required)

Street Address Address Line 2 City State ZIP Code

Name of Family Physician(Required)

Physician Phone(Required)

Physician Address(Required)

Street Address Address Line 2 City State ZIP Code

Camper Groups

Please list any campers your child requests to be grouped with (siblings, friends, etc.)

Referral

How did you hear about Jesuit's Day Camp?

Other campers

Jesuit’s website

Email from Jesuit

Relative or friend attends/attended Jesuit

Previously attended

Authorized Persons for Pickup(Required)

In regard to the pick-up of your child from Jesuit Day camp, no child will be allowed to enter any vehicle at the end of the camp day unless the Jesuit-authorized pick-up card given to the registering parent is displayed on the dashboard of the vehicle. Two (2) cards will be provided to each registering parent. The registering parent must list below any and all persons who are authorized to pick up the child from day camp when the person does not have a pick-up card on the vehicle or during the camp day. Jesuit will not release the child to any person other than those listed below.

Parental Consent(Required)

I grant permission for my child to participate in the Jesuit Summer Day Camp, including all off-campus field trips. I further understand the participant(s) officially enrolled in the camp will be insured by a commercial carrier contracted by Jesuit High School. If injured during camp activities, I will allow my child to be taken to the hospital for care. Camp administrators have my permission to dispense above listed medications.

By placing my initials in the box below, I agree to the terms stated above.

Photo Release(Required)

I grant permission for Jesuit High School of New Orleans (Jesuit) to photograph or film my child’s name, image, likeness, spoken words, student work, and performance with or without associating names thereto and in any form (hereinafter collectively referred to as “Works”), and to use, publish, display, distribute, produce, duplicate, sell, and copyright these Works in connection with any promotional material that may be created by Jesuit High School. I waive any claim for compensation of any kind for the School’s use or publication of the Works of my son.

I hereby release, discharge, and agree to hold harmless Jesuit and those acting under its authority from any liability to the extent provided by the law, for use or publication of the Works described above.

By placing my initials below, I agree to the terms stated above.

Payment

Total

Price includes a $50 non-refundable registration fee.

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code