registration form brochure 2010

8/14/2019 Registration Form Brochure 2010

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SPIRITUAL FORMATION

Camps Kateri Tekakwitha combine demanding outdoor activities

with powerful spiritual instruction bringing about a unique

encounter with God. Although our adventure activities arememorable, often the love that campers experience throughprayer is what kids remember most. Your child will have the

opportunity to experience different forms of prayer during camp.

Adoration, Reconciliation, veneration of the cross, rosaries,litanies, Mass, informal group prayer and individual

reflection are among the many styles of prayer we

practice here. These prayer experiences will have alasting impact on campers ONLY IF they are livedout and continued. We encourage you to pray for

your children during camp and with them aftercamp.

FromI-35,taketheW

illiamsburgexit(#170

)and

drivesouth,awayfro

mgasstation,8/10ofa

mileto

WilliamStreet.(Williamsburgsmainstreet)

.Turn

right(west)onWillia

mStreetanddrive1/10ofa

mile.Turnleft(South)onCaliforniaRoad(g

ravel

road).Proceedapproximatelymile.PrairieStar

Ranchisontheright

(largestonesmarkentrance).

DIR

ECTIONS

VISITORS/USE OF PHONE

Campers do not have access to phones. Camp directors will

monitor any need for campers to use the phone. Parents may calloffice personnel to check on their childs well being.

We strongly encourage parents to write yourchild and place letters in inner-camp mail onopening day of camp; they really do enjoy getting

your letters. Letters that are received, via the mail,

after a camper has left, will be shredded. Onlyauthorized guests are allowed on the premises

during camp sessions. No pets allowed.

CHARGES/REFUNDS

A $100 non-refundable deposit is due with each registration.

The balance is due May 15. Registrations submitted after May 15need to include full payment. If cancellation becomes necessary,

and if your campers spot can be filled, you will receive a refundminus your deposit. Refund claims must occur within one monthof the camp session closing. If a camper is wait listed and does

not get into a camp, the deposit check is voided and destroyed.

Please use the following numbers to answer your questions:

Registration Questions (Calls returned in 24-48 hours)

Camp Info Line 913-647-3054 or [email protected]

Camp Policies/Camp Activities

Shawn Madden 785-746-5693 or [email protected]

Donations/Camp Safety

Dana Nearmyer 913-647-0331 or [email protected], (June 1-Aug 8) 785-746-5693

To Download Forms and Brochures: go to www.archkck.org,Mary Rukavina 913 647-0373 or [email protected]


5/12

ww

w.archkck.o

rgregistero

n-line!

RegistrationInstructionO

verview

INTERNETAND

MAILAPPLICANTSMUSTALLTURN

IN

THE

ENCLOS

ED

REGISTRAT

ION

FORMSA.S.A.

P.AFTER

FEB

1,2010orFEB.8,2010

Tim

elineandMethodsofRegistration:

Registrationbeginsfor

7ththru12thgradecampersonFebruary1,2

010(Online9:00a.m.).

Registrationbeginsfor

5th&6thgradecampersonFebruary8,2010

(Online9:00a.m.).

Registrationspostmarked

and/orreceivedpriortoF

ebruary1stfor7ththru12thgradecamperswillbe

returned.Registrationpostmarkedand/orreceived

priortoFebruary8thfor5th&6thgradecampersw

illbe

returned.PleaserespecttheFebruary1standFebruary8thregistrationdates

orthiscouldcauseyourchildto

losehisorherplace!NO

HAND-DELIVEREDR

EGISTRATIONSWILLBEACCEPTED.

Campsessionsfillveryquickly!Spotsarereserved

onafirst-come,first-servebasis.Manycampspots

are

availableforregistrationsreceivedthroughthemail.H

owever,weencouragethe

useofouronlineregistration

system.Usingonlineregistrationwillgiveyouinstantconfirmation.Mailapplicantswillreceivea

confirmationorwaitlistletterthreeweeksafterreg

istration.Finalbalances

aredueMay15,thruonlineor

checkpaymentoptions.

Toregistergotowww.ar

chkck.organdfollowregistrationinstructions.Ifyo

uwishtobecomeamemberof

ouron-linecommunity,gotoLoginandCreateaNewAccount.Membershipwillinsureyourreceiptof

campupdatesviae-mail.

Registrationsarenotacceptedwithoutcompletedhealthforms,aphotocopyofhealthinsurancecard,

walletsizephotoofcamper(willnotbereturned)andanon-refundableandn

on-transferabledepositamount

of$100.Eachcamperwillneedtobringtocamponopeningday,theHealthEx

amWaiver(onepageArchkck

form)orasportsphysical,

notmorethan24monthso

ld,signedbyalicensedmedicalprofessional.

Plea

seusethefollowingnumberstoansweryo

urquestions:

RegistrationQuestionsCampInfoLine913-647-3054orjenniferarchkck@sun

flower.com

Cam

pPolicies/CampActivitie

sShawnMadden785-7

[email protected]

Donations/CampSafetyDan

aNearmyer913-647-033

[email protected],

(June1-Aug3)785-746

-5693

Pleasegiveus24-48hourstoreturnyourcallsbeforecallingagain.

ToD

ownloadFormsandBrochuresgotowww.archkck

.org.Campbrochureincludespoliciesandprocedu

res,

arriv

alanddeparturetimes,directions,packinglist,etc.

Beforeyoucall,please

checkthewebsiteforthe

answ

erstoyourquestions.

Fam

ilyCamp:

The

informationinthispack

etdoesnotcompletelye

xplainfamilycamp.Fam

ilycampisanextraordinary

expe

rienceaboutwhichwelo

vetospreadtheword.Allfamilieshavetheirow

ncabin.Allcabinsa

re

air-c

onditioned.Eachfamily

hasitsownwaitstaff.M

ealsarereallyfun.Tablesareclearedbyyour

personalwaitstaff.Thepriceisall-inclusive,(notippingplease).Familycam

pbringsfamiliescloser

together.Teens,toddlers,pa

rentsandgrandparentslovefamilycamp.CallDanaNearmyerat913-647-0331

[email protected](June

1-Aug8)785-746-5693

ifyouhaveanyquestionsaboutfamilycamp.

YouthResidentialCampScholarshipsareavailable.Applications

aredueJanuary20,

2010.

Ifyo

umissthescholarshipde

adline,youmaymailyourapplicationlate.Inthe

eventadditionalfundsare

donated,additionalapplicatio

nswillbeconsidereddur

ingtheregistrationproce

ss.Forspecificquestions

rega

rdingyourapplicationsu

bmission,[email protected].


6/12

CAMPSKATERI

TEKAKWITHA2010

AllCam

psareHeldat:

PRAIRIE

STARRANCH

1124C

aliforniaRoad

Williamsburg,Kansas66095

HEALTHE

XAMWAIVER

CAMPERSNAME:________________________

_________________________

CAMPERSADDRESS:_____________________

_________________________

CAMPSESSION/DATE

:__________________________________________

___

CAMPERSGRADEFALL2010:_____________

_________________________

____________________

_____________

(camper)isphysicallyfittoattendca

mpatCampsKateri

Tekakwitha.Thedateof

lastexamwas__________

_______________

(within

thepast24months).Pleaselist

currentongoingtreatmentsormedications,if

any.____________________________________________________________________.

Date_________________.

___________________________________

LicensedMedicalProfessional

Date_________________.

___________________________________

ParentorGuardian

Thecampsofferhorsebackriding,highropeschalle

nge,canoeing,hiking,orie

nteering,rockclimbing,

rappelling,basketball,soccer,swimming,grouppartygames,archery,volleyba

ll,mountainbiking,mountain

boarding,outdoorcampin

g,softball,numerousCatholicprayerandsacramentalexperiences,andother

outdoorcampactivities.Notallactiviteswillbeava

ilablefor5th &6th gradecampers.Nocamperwillbe

forcedtoparticipateinan

yactivityatwhichtheyare

uncomfortable.

THISFORM

SHOULDBEBROUGHTTOCAMPON

OPENINGDAY.

DON

OTMAIL.


7/12

CAMPS

KATERIT

EKAKWIT

HA2004

RegistrationAddress:Cam

pTekakwitha A

rchdioceseo

fKCinKS 1

2615ParallelParkway K

ansasCity,KS66109

CampAddress:PrairieStarRanch 1124California

Road,Williamsburg,Kansas66095 Tel785/746-569

3

CAMPS

KATERIT

EKAKWITHA2010

@PrairieStarRanch

P

leasemailto:CampTekakwithaArchdioceseofKCinKS1

2615ParallelP

arkwayKansasCity,KS

66109

REG

ISTRATION&HEALTHFORM

-FORALLYOUT

HCAMPS

ListChoicesinOrderFromF

irstToLast(1,2,3,4,).







PleasenoteN

/AforsessionsthatyourcamperisNotAvailabletoattend

.

PleasenoteN


.

PleasenoteN


.

PleasenoteN


.

Tekakwitha

&X-Treme

Entering9th12th

gradesinFall2010

(includinggrad

uatingseniors)

CampTe

kakwitha

June21-26$

380__________

Tekakwith

a-X-Treme

July26-Aug3

$430________

Pleaseseebrochurefor

arrival/departuretimes

PRIORTOregisteringyourchild.

Camps

Kateri

Entering5th&6th

gradesFall2010

Term1

June1-3

$230______

Term2

June4-6

$230_______

Term3

June28-30

$230_______

Term4

July6-8

$230______

Pleaseseebrochurefor

arrival/departure

timesPRIORTOregisteringyourchild

FamilyCamp

July16-18

Agesnewborn2

Free

(nobab

ysittingprovided)

Ages2yearsandUp$125

SEEFAMILYC

AMPFORMTOSIGN

UP

Camp

sTekakwitha

Entering7th

&8thgradesFall2010

Term1

June

7-12

$370_______

Term2

June

14-19

$370_______

Term3

July10-15

$370_______

Term4

July19-24

$370_______

Pleaseseebroch

ureforarrival/departuretimes

PRIORTO

registeringyourchild.

VeryImporta

nt!Haveyoualread

yreservedaspotonline?YES/NO.

C

ampersName___________________________

_________

Age(atcampt

ime)_____

DOB:__

/___/___

G

radeinupcomingyear_

__________

MALE

FEMALE

Phone#

(_____

)________________

StreetAddress_________

______________________________ParentEmail__________________

___

C

ity_________________

__________________________

State________

____

Zip______________

Parish___________________________________

_______

ParishCity___

_______________________

M

othersName________

_________________Ph

one(Day)(____)________

(Evening)(____)______

___

M

othersCompleteAddre

ss(ifdifferentthancamper)__

_______________________________________

___

FathersName__________________________

Phone(Day)(____)________

(Evening)(____)______

___

FathersCompleteAddress(ifdifferentthancamper)___

_______________________________________

___

Emergencycontact(incase

youcantbereached)_______

_______________________________________

___

Phone#(____)_____________________

Relation

tocamper______________________________

___

O

necabinmate,ofsamegenderandgrade,requestispermitted____________________________

___

(Seecamppacketfo

rcabinmaterequestdeta

ils)

Emergencynumbers(cell

phonenumbers)forparentsduringcampweek________________________

_____________________

_______________________________________

_______________________

Page 1 of 3 Youth Residential Camp


8/12


Pleasenotethereare4requiredsignatures!!!

Isthisparticipantingeneralgoodhealthandabletoparticipateinnormalcampactivities?

Yes_____

No

_____

Dateofmostrecentphysica

lexaminationbyalicensedmedicaldoctor.Date:__

__/____/____

(Ifupcomingappointmentset,pleasenote:_______________________________

__________________________.

)

!!!!VERYIMPORTANT!!!!

YouMUSThavewrittenverificationFROMLICENSEDMEDICALPERSONNELthatthecamperha

shada

healthexaminationdur

ingthepast24monthsand

therecordSHOULDINC

LUDE:anyphysicalcondition

requiringrestrictionsonparticipationincampand

descriptionsthereof,dateofexam,andcurrenton-go

ing

treatmentsormedications,andtherecordshouldbesignedanddated.PleasefilloutourHealthExamWaiver

(onepageArchkckform)orasportsphysical,not

morethan24monthsold,signedbyalicensedmedical

professional.THISINFORMATIONMUSTBEBROUGHTWITHYOUT

HEFIRSTDAYOFCAM

P.

PLEASEDONOTMAIL.(ThisInformationRe

quiredbyAmericanCampingAssociation).(HealthE

xam

Waiverformattachedtocamppacket.)

DoctorsNameandClinic:______________________

___________________________________________

_____

DoctorsFullAddress:_________________________

___________________________________________

_____

DoctorsPhone#:(_____)_

___________________

Areallimmunizationsupto

date?Yes_____

No___

__

(Ifupcomingappointmentset,please

note:__________________

.)

Dateoflasttetanusbooster:____/____

/____

(Tetan

usBoostersareRequiredE

very10years.)

Ifanyarenotuptodateple

aselistthem.

______________________

___________________________________________

____

MEDICATION

Allergies/Conditions:(Checkifparticipantisallergictoanylistedorhasanyofthefollowingconditions)

BeeStings______

PoisonIvy______

Asthma______

Fainting______

Penicillin______

Sulfa______

Seizures______

HayFever______

Latex________

FirstAidAntiseptics____

Antibiotics_____

Other________

Ifanyoftheabovewerecheckedyes,pleasesubmita

statementinspaceprovidedbelowofhowthechildhasbeen

treatedandwithwhatmedications.Pleasealsolist(us

ebackofpage3ifnecessa

ry):

1.Anyoperationsorseriousinjuryinthepasttwoyears.

2.Medicallimitations

orneedsthatweneedtobeawareof.

3.Anylimitationsorn

eeds(learningstyles,familysituations,custodyarrangements,etc.)

Ifyourson/daughterwillbe

takingover-the-counterorprescriptionmedicationswhileatcamppleaselistALL

medications(over-the-coun

terANDprescriptions)nam

e,dosageandfrequencyo

na3x5cardandplaceina

ziploc

bagwithyourchildsname

onitalongwiththemedications.Prescriptionmedicationsmustbeinoriginalcontainer.

Anychangesinmedication

mustbereportedwhenreg

isteringatcamp.Nomedication,evenTylenol,willb

e

dispensedtoyourchildotherthanwhatyouprovide,u

nlessanemergencysituationdictates.PleasesendTy

lenolif

youchildissusceptibletoh

eadaches.

Theziplocbag,andallothermedication,prescriptionandnon-prescriptionmedicationwillbecollectedat

registrationanddispensedbytheassignedteamperson.YouthmaynotkeepANYmedication.

#1Signature________________________________

_________________________

Date_____________

___

(Parentor

Guardianpleasesignevenifchildnotonmedication)


9/12


Pleaselistanyspecialdietaryneedsforyourchild.___________________________________________________

______

___________________________________________

___________________________________________

Notify

thedirectorifthischildisexposedtoanycommunica

blediseaseduringthethreeweekspriortocamp

Parentswillbenotifiedoffever,v

omiting,intensehomesicknessoranxiety,areasthatrequiregauzebandaging,x

-raysor

stitchin

g,andofothersituationso

fconcerntodeterminethe

courseofactiontobetaken.

Incase

ofmedicalemergency,Iunderstandthateveryeffort

willbemadetocontactparentsorguardiansofcamper.Inthe

eventthatIcannotbereached,IherebyrequestandgivepermissiontothephysicianselectedbytheCamptohospitalize,

securepropertreatmentfor,andtoorderanesthesiaorsurgeryformychild,asnamedh

erein.Insigningthishealthform,I

hereby

certifythattheinformation

iscorrectandgivepermis

sionforthereleaseofmedicalrecordstoanattending

physician

incase

ofillnessoremergency.I

requestthatmychildbetransportedtoseekneededm

edicalattention.

#2ParentorGuardianSignature________________

______________________________

Date________

_______

Health

InsuranceCompany_____

___________________________________________

______________________

Health

InsurancePolicy#______

___________________________________________

______________________

PrimaryHealthInsuranceholder,

nameandSocialSecurity#________________________________________

APhotocopyofthePrimaryHealthInsur

ancecardMUSTbesubm

ittedwiththisform.

Irequestthatmychild_________

___________

beallowedtoparticipateinthecampactivitiesatCampKaterior

Camp

Tekakw

ithaattheArchdiocesanC

ampinWilliamsburg,KS.IherebyreleaseandindemnifytheArchdioceseofK

ansasCity

inKansas,itsstaff,andvolunteersfromanyliabilityarisingfromclaimsofanykindor

naturewhatsoeverfrommychilds

participationinthisprogram.The

activitiesmayincludehor

sebackriding,highropesc

hallenge,powerkiting,stuntkiting,

canoeing,hiking,orienteering,rockclimbing,rappelling,basketball,soccer,swimming,technicaltreeclimbing,groupparty

games,

archery,volleyball,mountainbiking,mountainboarding,outdoorcamping,softball,numerousCatholicprayer

experie

nces,andotheroutdoorcampactivities.

#3Pa

rentorGuardianSignatu

re_________________________________________

_Date________________

FullAddress______________________________________

___________________________________________

SignatureofCustodialParent(ifa

pplicable)_____________

___________________________________________

PHOT

ORELEASE

IherebyauthorizetheArchdioceseOfKansasCityinKansas,anditsagentstoutilizem

ychildsphotographicimageforthe

specificpurposeofpublicationof

theArchdioceseOfKansasCityinKansasevents(includingpromotionalmaterials).In

givingmyconsent,IherebyreleaseandholdharmlesstheArchdioceseOfKansasCity

inKansasanditsagentsfromanyand

allresp

onsibilityorliability.Iund

erstandthatIwillreceivenocompensation,shouldanyphotographofmeormy

childbe

used.

#4ParentorGuardianSignature________________

__________________________________

Date____

_________

TRAN

SPORTATIONHOME

Attheconclusionofcamp,yourc

hildwillbeleavingwithhis/herparents.Yes_____N

o_____

Iamno

tabletopickupmychildfromcamp;he/shehasmy

permissiontoridehomewith___________________________

Campe

rwillnotbeallowedtolea

vewithanyonewhoisnot

namedonthisform.

COMP

LETINGREGISTRATIONRegistrationisNOT

completewithoutthefollowingitems:

1.

Makesureallblanksontheformarecompleteandallfoursignatureblanksaresigned.

2.

Encloseaphotocopyofhealthinsurancecard.

3.

Sendawallet-sizephoto

ofcamper(willnotberetu

rned).

4.

En

5.

6.

Enclosea$100non-refundabledepositcheckmadepayabletoCampTekakwitha.

5.

EarliestACCEPTEDpostmarkdate:February1,2010,for7ththru12gradec

ampers

andFebruary8,2010,fo

r5th&6thgradecampers.

Earlierpostmarkswillbe

returned!


10/12

FAMILY

CAMPTEKAKWITH

A2010

PrairieStarRanch

Pleas

emailto:CampTekakwithaArchdioceseofKCinKS12615ParallelParkway

KansasCity,KS66109

REGIST

RATION&

HEALTH

FORM

FORJu

ly16-18FAM

ILYCAMPO

NLY

Pleaseprintanduseblueorbla

ckinkonly.

Camper

sName________________________________

____Age(atcamptime)_____DOB:__/___/___

Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


Camper

sName________________________________


HomeP

hone#(_____)________________

A

dditionalPhone#(____

_)________________

StreetA

ddress______________

__________________E

-mailAddress________

_________________

City______________________

_____________________State____________

Zip______________

Parish_

_______________________________________

_ParishCity_________

_________________

MothersName_____________

___________Phone(Day

)(____)________(Evenin

g)(____)_________

MothersCompleteAddress(ifdifferentthanabove)________

____________________________________

FathersName_________________________Phone(Day)(____)________(Evenin

g)(____)_________

FathersCompleteAddress(ifdifferentthanabove)____________________________

_________________

AdditionalEmergencycontactincaseyoucannotbereached(notatcamp):

__________________________________________________________

_____________________________________

Phone#

(____)_____________________Relationtoparents_________________________________

Age

#ofcampers

Cost

Total

Age0-2(nobabysitting)

__________

FREE

________

Ages2yearsoldandup

__________

$125

________

TOTALS

___

_______

________

Family Camp Page 1 of 3


11/12

Please

notethereare3areas

requiringsignatures!!!

DoctorsNameandClinic:____________________________

__________________________________________

DoctorsFullAddress:_______________________________

__________________________________________

DoctorsPhone#:(_____)_______

_____________

Areallimmunizationsuptodate?

Yes_____No_____

Datesoflasttetanusboosterforeachfamilymember:____________________________

____________________

___

___________________________________________

__________________________________________

Ifanyarenotuptodatepleaselist

them.______________________________________

____________________

Pleaselistanyspecialdietaryneedsforyourfamily._____________________________

____________________

___

___________________________________________

__________________________________________

Notifythestaffifanyfamilymemberisexposedtoacommun

icablediseaseduringthethreeweekspriortocamp.

Allergies/Conditions(Listwhichfamilymemberisallergictoorhas

anyofthefollowingconditions):

BeeStin

gs______

PoisonIvy______

Asthma

______

Fainting______

Penicillin______

Sulfa__

____

Seizures______

HayFever______

Other_______________________

___________________________________________

_____________________

Ifanyoftheabovewerecheckedy

es,pleasesubmitastateme

ntinspaceprovidedbelow

ofhowthefamilymember

hasbeen

treatedandwithwhatmedications.Pleasealsolist(usebackofpage3ifnecessary):

1.Anyoperationsorseriousinjuryinthepasttwoyears.

2.Medicallimitationsorneed

sthatweneedtobeaware

of.

3.Anylimitationsorneeds(learningstyles,familysituations,custodyarrangements,etc.)

Areallofyouthfamilymemberthatarecomingtocampinge

neralgoodhealthandable

toparticipateinnormal

campac

tivities?

Yes_____No_____

!!!!VERYIMPO

RTANT!!!!

YouMU

SThavewrittenverificationFROMLICENSEDME

DICALPERSONNELthatthecamperhashada

healthexaminationduringthepast

24monthsandarecordSH

OULDINCLUDE:anyph

ysicalconditionrequiring

restrictionsonparticipationincampanddescriptionsthereof,

dateofexam,andcurrenton-goingtreatmentsor

medications,andrecordshouldbesignedanddated.Ifyoualreadyhaveasportsphysicalformfromthepast24

months,

itwillalsobesufficientforverificationofcampersh

ealth,oruseourHealthEx

amWaiver(onepage

Archkck

Form)includedinthispacket.THISINFORMATIO

NMUSTBEBROUGHT

WITHYOUTHEFIRST

DAYOFCAMP.PLEASEDON

OTMAIL.(ThisInformationRequiredbyACA).

Dateofmostrecentphysicalexaminationbyalicensedmedic

aldoctor.Date:____/____/____









(Ifupcomingappointmentset,plea

senote:_____________________________________

_____________.)

Incaseofmedicalemergency,Iun

derstandthateveryeffortw

illbemadetocontactparentsorguardianofcamper.

IntheeventthatIcannotbereache

d,IherebyrequestandgivepermissiontothephysicianselectedbytheCampto

hospitalize,securepropertreatmen

tforandtoorderanesthesiaorsurgeryformychild,a

snamedherein.Insigning

thishealthform,Iherebycertifyth

attheinformationiscorrec

tandgivepermissionforthereleaseofmedical

recordstoanattendingphysicianincaseofillnessoremergen

cy.Irequestthatmychild

betransportedtoseek

neededmedicalattention.

#1SignatureofParent/Guardian___________________

________________________Date_____________

FAMILY

CAMPTEKAKWITH

A2010

PrairieStarR

anch

Page2of3ofFamilyCam

pRegistration



12/12

#1

SignatureofParent/Guardian_______________________________________

____Date_____________

#1

SignatureofAdultFamilyMember_____________

__________________________Date____________

_

#1


__________________________Date____________

_

Health

InsuranceCompany_______________________________________________

_______________________

Health

InsurancePolicy#___________________________

___________________________________________

_

PrimaryHealthInsuranceholder

andnameandSocialSecurity#_________________

_______________________

APhotocopyofthePrimaryHealthInsurancecardMUSTbesubmittedwiththisform.

Irequestthatmyfamily_______

_____________beallowe

dtoparticipateinthecamp

activitiesatFamilyCamp

Tekak

withaattheArchdiocesanCampinWilliamsburg,KS

.Iherebyreleaseandinde

mnifytheArchdioceseof

Kansa

sCityinKansas,itsstaff,andvolunteersfromanylia

bilityarisingfromclaimso

fanykindofnature

whatsoeverfrommychildsparticipationinthisprogram.T

heactivitiesmayincludehorsebackriding,highrope

s

challenge,powerkiting,stuntkiting,canoeing,hiking,orien

teering,rockclimbing,rap

pelling,basketball,soccer,

swimm

ing,technicaltreeclimbin

g,grouppartygames,arch

ery,volleyball,mountainb

iking,mountainboarding,

outdoorcamping,softball,numerousCatholicprayerexperiences,andotheroutdoorcampactivities.

#2


____Date_____________

#2


____Date_____________

#2


__________________________Date____________

_

#2


__________________________Date____________

_

PHOT

ORELEASE

IherebyauthorizetheArchdioceseOfKansasCity,anditsagentstoutilizemychilds

photographicimageforthe

specificpurposeofpublicationoftheArchdioceseOfKansasCityevents(includingpromotionalmaterials).In

giving

myconsent,Iherebyrelea

seandholdharmlesstheA

rchdioceseOfKansasCity

anditsagentsfromanyan

d

allresponsibilityorliability.IunderstandthatIwillreceive

nocompensation,shoulda

nyphotographofmebeus

ed.

#3


____Date_____________

#3


____Date_____________

#3


__________________________Date____________

_

#3


__________________________Date____________

_

Pleasemailto:

CampTekakwitha

ArchdioceseofKC

inKS

12615ParallelParkway

KansasCity,KS6

6109

RegistrationsMUSTBE

postmarked;handdelivered

registrationswillNOTbeaccepted.

FAMILYCAMPTEKAKWITHA2010

PrairieSta

rRanch

Page3of3ofFamilyC

ampRegistration


registration form brochure 2010

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