2022 Camp Viking Summer Camp Registration Form

2022 Camp Viking Summer Camp Registration Form

Choose your own adventure at Camp Viking! Enjoy weekly themes that incorporate arts & crafts, fitness, games and more! Camp Viking is open to 3-year-olds through 8th grade students. In 2022, camp begins May 31st and runs from 7:30 a.m. until 6 p.m., daily, throughout the summer. Camp Viking offers parents flexibility—kids can attend all eight weeks or just the weeks you need. Campers DO NOT have to be St. Anne-Pacelli Catholic School students.

More Camp Viking details:
*Hours of Operation: Monday-Friday, 7:30 a.m.-6 p.m.
*Camp begins the week of May 31st and runs through July 29th. Please note: There is no camp the week of July 4th.
*One-time registration fee: $30 (non-refundable, guarantees spot in camp and includes t-shirt for those who register by May 2, 2022)
*Weekly Rate: $150 (includes morning & afternoon snacks and supplies for activities; due on the Monday of the week that the child attends)
*Campers must bring a lunch with a drink
*Camp Viking participants must be checked in and out of camp in St. Anne-Pacelli’s Lower School Cafeteria each day (Kay Circle entrance)

Please complete one registration form per camper. Your camper's $30 registration fee and weekly camp fee(s) will be invoiced via FACTS. All St. Anne-Pacelli families have a FACTS account. Non-school families will need to visit https://online.factsmgt.com/signin/3CDW1 and follow the instructions to create a new account.

Questions? Email Camp Viking Director Sheryl Ivey - sivey@sasphs.net.

Camper's Name Camper's Name * First Last
Camper's Gender *

Camper's Gender Male Female
Camper's Age *
Camper's Date of Birth Camper's Date of Birth * / MM / DD YYYY
What school does your camper attend? *
Grade Entering in 2022-2023
All rising Kindergarten-8th graders may attend; rising Pre-K4 St. Anne-Pacelli students may attend as well *

Grade Entering in 2022-2023
All rising Kindergarten-8th graders may attend; rising Pre-K4 St. Anne-Pacelli students may attend as well Pre-K3 Pre-K4 Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade
Home Address Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Parent Email *
Camper T-shirt Size *

Camper T-shirt Size Youth XS Youth Small Youth Medium Youth Large Youth XL Adult Small Adult Medium Adult Large Adult XL
Select the weeks your camper will attend Camp Viking (please note there is no camp the week of July 4th): *

Select the weeks your camper will attend Camp Viking (please note there is no camp the week of July 4th): All 8 weeks! Week 1 - 5/31-6/3 Get Active! Week 2 - 6/6-6/10 - Space Jam Week 3 - 6/13-6/17 - Disco Daze Week 4 - 6/20-6/24 - Lights, Camera, Action Week 5 - 6/27-7/1 - Celebrate America Week 6 - 7/11-7/15 - Around the World Week 7 - 7/18-7/22 - Bless this Mess Week 8 - 7/25-7/29 - Wet & Wild
Camper lives with *

Camper lives with Both parents Mother Father Other Other
Camper's legal guardian is *

Camper's legal guardian is Both parents Mother Father Other Other
Mother's Name Mother's Name First Last
Mother's Cell Phone Mother's Cell Phone - ### - ### ####
Mother's Place of Employment
Mother's Work Phone Mother's Work Phone - ### - ### ####
Father's Name Father's Name First Last
Father's Cell Phone Father's Cell Phone - ### - ### ####
Father's Place of Employment
Father's Work Phone Father's Work Phone - ### - ### ####
Camper's Physician's Name Camper's Physician's Name * First Last
Physician's Phone Number Physician's Phone Number * - ### - ### ####
Camper's Health Info (check all that apply)

Camper's Health Info (check all that apply) ADD/ADHD Epilepsy/Seizures Asthma Food Allergies Vegetarian Other Conditions/Needs Other Conditions/Needs
Please list any allergies, special needs or accommodations that may be required to meet your child's needs while at Camp Viking.
Please list all medications your child is taking.
My child may be released to the following people (we will ask for ID)
My child may NOT be released to the following people
Camp Waiver: I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend St. Anne-Pacelli Catholic School, its officers, directors, employees and agents, chaperones, or representatives associated with camp, from any claim arising from or in connection with my child attending camp or in connection with any illness or injury (including death) or cost of medical treatment in conjunction therewith, and I agree to compensate the school, its officers, directors, and agents, and the Diocese of Savannah, its employees and agents and chaperones, or representatives associated with the expenses which they may incur in any action brought against them as a result of such injury or damage, unless such claim arises from the negligence of the school/diocese.

Emergency Procedures: In the event of serious injury or illness, Camp Viking staff will attempt to contact the parent/guardian or emergency contact immediately. The staff will call 911. If the situation warrants, the child will be taken to St. Francis Hospital. A staff member will stay with the child until a parent or authorized person arrives.

Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
As a family, St. Anne-Pacelli Catholic School records, promotes and celebrates special events, activities, athletics, field trips, etc., through the use of photos, videos and digital media. These are used in many ways, including but not limited to: our school’s website – www.BeAViking.com; social media (the school’s Facebook, Twitter and Instagram accounts); school publications; and press releases to media.

CONSENT TO INTERVIEW, PHOTOGRAPH, FILM, OR VIDEOTAPE A GUEST * *

As a family, St. Anne-Pacelli Catholic School records, promotes and celebrates special events, activities, athletics, field trips, etc., through the use of photos, videos and digital media. These are used in many ways, including but not limited to: our school’s website – www.BeAViking.com; social media (the school’s Facebook, Twitter and Instagram accounts); school publications; and press releases to media.

CONSENT TO INTERVIEW, PHOTOGRAPH, FILM, OR VIDEOTAPE A GUEST * I hereby consent to the participation in interviews, taking of photographs, movies and videotapes of the Camper named above. I also grant St. Anne-Pacelli Catholic School the right to edit, use, and re-use said products for non-profit purposes, including print, Internet, and all other forms of media. During this usage, the Camper named above may be identified by first and last name. I also hereby release St. Anne-Pacelli Catholic School and its agents and employees from all claims, demands, and liabilities whatsoever in connection with the above. I object to the release or use of the above named Camper’s likeness in any interview, photograph, movie, or videotape that will be produced, used or distributed by St. Anne-Pacelli Catholic School for school purposes.
Draw your signature into the box below. *

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.