COTE | Camper Registration Form - Nativity Catholic Church

Parent/Guardian Information

Parent/Guardian(Required)

Parent First Name Parent Last Name

Cell Phone(Required)

This number will be used to send Flocknote text reminders during camp.

Email(Required)

Are you a Nativity parishioner?(Required)

Yes

No

Are you interested in being a volunteer for this program?

Yes

Maybe

No

How many campers are you registering for Camp on the Edge (COTE)?(Required)

COTE is for students currently in grade.s 5th, 6th, 7th, and 8th during the 2023-2024 school year (NOT by rising grade level)

PLEASE NOTE: Capacity is now FULL for 5th, 6th, and 8th grades. If you child is in one of these grades, please add them to our waitlist here

We are unable to accommodate early/late arrivals or pickups, especially since some of our activities will be off-site. Additionally, campers must be present for all sessions. Are you aware of any conflicts with the schedule that would require your camper(s) to miss a day or be picked up outside of the normal schedule?(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Emergency Contact Information

Please list the person who would be available to pick up the child in case of illness or emergency.

Emergency Contact(Required)

Emergency: First Name Last Name

Relationship to child(ren)?(Required)

Cell Phone(Required)

Camper #1

Name(Required)

Camper 1: First Name Last Name Nickname

Date of Birth(Required)

School Grade 2023-2024(Required)

PLEASE NOTE: Capacity is now FULL for 5th, 6th, and 8th grades. If you child is in one of these grades, please add them to our waitlist

T-Shirt Size(Required)

Anything special we should know about your child?

Briefly describe anything that we should know about your child (e.g. ADHD, Anxiety, sensory issues, first time at COTE, COTE veteran, best friend attending, new to parish, military transfer, etc). This information will remain confidential with the Director of Youth Ministry and shared only with adult group leaders as needed.

Health Information(Required)

Please let us know of any medical conditions, medication, EpiPen use, or allergies that may affect the participant’s involvement.

Primary Care Provider(Required)

Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Insured? 1

Check box if child is currently uninsured

Youth Safety Agreement Signature(Required)

As the participant, I agree to follow all procedures, safety precautions, and rules and regulations set forth by the Diocese and the Parish.

Camper #2

Name(Required)

Camper 2: First Name Last Name Nickname

Date of Birth(Required)

School Grade 2023-2024(Required)

PLEASE NOTE: Capacity is now FULL for 5th, 6th, and 8th grades. If you child is in one of these grades, please add them to our waitlist

T-Shirt Size(Required)

Anything special we should know about your child?

Briefly describe anything that we should know about your child (e.g. ADHD, Anxiety, sensory issues, first time at COTE, VBC or COTE veteran, best friend attending, new to parish, military transfer, etc). This information will remain confidential with the Director of Youth Ministry and shared only with adult group leaders as needed.

Health Information(Required)

Please let us know of any medical conditions, medication, EpiPen use, or allergies that may affect the participant’s involvement.

Primary Care Provider(Required)

Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

Insured? 2

Check box if child is currently uninsured

Youth Safety Agreement Signature(Required)

As the participant, I agree to follow all procedures, safety precautions, and rules and regulations set forth by the Diocese and the Parish.

Camper #3

Name(Required)

Camper 3: First Name Last Name Nickname

Date of Birth(Required)

School Grade 2023-2024(Required)

PLEASE NOTE: Capacity is now FULL for 5th, 6th, and 8th grades. If you child is in one of these grades, please add them to our waitlist

T-Shirt Size(Required)

Anything special we should know about your child?

Briefly describe anything that we should know about your child (e.g. ADHD, Anxiety, sensory issues, first time at COTE, VBC or COTE veteran, best friend attending, new to parish, military transfer, etc). This information will remain confidential with the Director of Youth Ministry and shared only with adult group leaders as needed.

Health Information(Required)

Please let us know of any medical conditions, medication, EpiPen use, or allergies that may affect the participant’s involvement.

Primary Care Provider(Required)

Provider Phone(Required)

Health Insurance Company(Required)

Policy Number(Required)

insured? 3

Check box if child is currently uninsured

Youth Safety Agreement Signature(Required)

As the participant, I agree to follow all procedures, safety precautions, and rules and regulations set forth by the Diocese and the Parish.

Parental Permission & Consent

Parent/Guardian Signature(Required)

I understand and hereby agree to the terms and conditions of the participant’s involvement in the above-described event, and I freely execute this Acknowledgement with full knowledge of its content.

Type Your Full Legal Name(Required)

COTE Registration Fee

Please allow a few seconds for the page to redirect to PayPal for your payment. You do not need an account to pay via PayPal. Once payment is complete, you will receive payment and registration confirmation emails. Thank you!

COTE: Fee for 1 Camper

Price:

COTE: Fee for 2 Campers

Price:

COTE: Fee for 3 Campers

Price:

Name

This field is for validation purposes and should be left unchanged.