Camp Bosco

Jr. High Day Camp

Name of Event: Camp Bosco
Dates: August 8-11
Time: 9:00am-5:00pm
Destination: MOS and local areas

(Pittsburgh (Kayaking), Idelwild,

Export(Bowling) Murysville (Duff Parkexploring)
Designated Supervisor of Activity: Youth Minister and designated chaperones
Method of Transportation: School Bus
Student Cost: $100 (if you volunteered for VBS you pay a discounted price of $75)
Extra Info: Camp Bosco is a 4 day long Day Camp designed for 6-8th grade students to dive
deeper into their faith. We will discover more about prayer, praise and Worship music
and the life of St. John Bosco, as well as learn that it is o.k. to live a full life doing things
that we love to do!
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Please return this entire form by July 29.
Youth Name
Age

Grade:
T-shirt Size (adult sizes): S M L XL XXL

Allergies or Special Needs

Parent Name
Home Address

City

Parent or Guardian Phone No (h)

Zip
(c)

Parent Email Address

Emergency Contact Name
Emergency Contact Phone No (h)

(c)

Relationship to Youth
Would you like to help with this event?

Yes

No

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Office Use Only
Date Rcvd

Cash or Check#

Amount

Parent/Guardian Consent/Release Form

Your son/daughter is eligible to participate in Camp Bosco, a Junior High Day Camp. This activity will
take place under the guidance and supervision of employees from Mother of Sorrows Parish and
designated adult chaperones. As parent or legal guardian, you remain fully responsible for any legal
responsibility which may result from any personal actions taken by the named student.
I hereby consent to participation by my child, _______________________________, in the event
described above.
I understand that my child will be under the supervision of the designated parish employees and
adult chaperones on the stated date. I further consent to the conditions stated above on participation in
this event, including the method of transportation. We do hereby release and forever discharge the
Diocese of Greensburg, Mother of Sorrows and designated chaperones from any and all actions or suits
in law or equity which we might hereafter have by reasons of injuries sustained by our son/daughter
participating in Camp Bosco at Mother of Sorrows Parish.

________________________________ Parent/Guardian Signature

In case of emergency, we give permission for our child to be treated at a hospital and/or by a medical
doctor.
In case of emergency, contact us at this phone number_______________________________
Emergency Contact (name/relationship)___________________________________________
(Phone number)_____________________________________________
Our Insurance Company is____________________________________________________
Policy Number______________________________________________________________
Parent/Guardian Signature ____________________________________ Date _____________

PHOTOGRAPHIC RELEASE LETTER

I hereby grant to the Diocese of Greensburg, Pennsylvania, and its respective licensees, successors and
assigns, the right and permission, with respect to those photographs taken of me or the minor named
below on whose behalf I am signing, and with respect to any printed or electronic matter in connection
therewith, to do the following:
1. To include such photographs on the Diocese of Greensburg website and on print material
2. To use my name, or the name of the minor on whose behalf I am signing, in connection with the
foregoing.
I hereby release, discharge and agree to indemnify and hold harmless the Diocese of Greensburg and its
legal representatives, licensees, successor and assigns, from all claims and demands whatsoever arising
out of or in connection with the foregoing, and waive any right to inspect or approve the same.
I hereby certify that I am the [parent and/or guardian] of ___________________________, a minor
under the age of eighteen years, and hereby consent on behalf of said minor to the use of any of the
photographs taken of said minor pursuant to the terms set forth in this Photographic Release, including,
without limitation, the release, discharge and hold harmless provisions thereof.
___________________________________________ Signature of Parent and/or Guardian
___________________________________________ Date