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Camp Trinity Registration Form

2013 Camp Trinity Registration Form

Please complete this online form to register for Camp Trinity, being held September 20-22, 2013. You will be able to register multiple people with this one form. If you have questions or problems registering with this form, please contact Marcie Wilson at mwilson@trinity.org

Are you registering a child/children that will NOT be accompanied by a parent?*
- Yes (Child is attending without a parent/guardian)
- No
List all adults (ages 21 and over) in your group. The first adult you list will be the primary contact who will receive all official information about Camp Trinity.
Adult #1 Name (to appear on nametag)*
FirstLast
Adult #1 Address*
Street AddressAddress Line 2CityStateZIP Code
Adult #1 Email*
Adult #1 Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of you on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You understand that you will not be paid any royalty or other compensation and you relinquish any right you may have to any payment if your photo is published.
- Yes
- No
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Are you registering a second adult?*
- Yes
- No
Second Adult Information
Adult #2 Name (to appear on nametag)*
FirstLast
Relationship to Adult #1*
Adult #2 Address (if different from above)
Street AddressAddress Line 2CityStateZIP Code
Adult #2 Email*
Adult #2 Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of you on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You understand that you will not be paid any royalty or other compensation and you relinquish any right you may have to any payment if your photo is published.
- Yes
- No
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Are you registering a child?*
- Yes
- No
Child #1
Child #1 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Registering A Second Child?
- Yes
- No
Child #2
Child #2 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Registering A Third Child?
- Yes
- No
Child #3
Child #3 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Registering A Fourth Child?
- Yes
- No
Child #4
Child #4 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Registering A Fifth Child?
- Yes
- No
Child #5
Child #5 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Registering A Sixth Child?
- Yes
- No
Child #6
Child #6 Information
Name (to appear on nametag)*
FirstLast
Relationship to Primary Contact*
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (as of September 2013)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No
Child with non-present parent
Parent Name*
FirstLast
Parent Address*
Street AddressAddress Line 2CityStateZIP Code
Parent Phone*
Parent Email*
Parent #2 Name
FirstLast
Parent #2 Address
Street AddressAddress Line 2CityStateZIP Code
Parent #2 Phone
Parent #2 Email
Responsible adult name (adult attending camp)*
FirstLast
Child's name (to appear on nametag)*
FirstLast
Age range (as of September 20th, 2013)*
- 8 - 20 years old
- 4 - 7 years old
- Under 4 years
Grade (2013-2014 School Year)*
Gender*
- Male
- Female
Child Photo Permission*
By choosing yes, you grant permission for Holy Trinity Catholic Church to publish pictures of your child on the church's website, social media sites, or in the church's publicity information, newsletters or bulletins. You further state that you have the right to grant or refuse this permission as the child’s parent or legal guardian. You understand that neither the child nor you will be paid any royalty or other compensation and you relinquish any right you or your child may have to any payment if a photo of your child is published.
- Yes
- No

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Rates for Camp Trinity 2013 are ShrineMont charges plus a small activity fee for the extras, such as the hayride, dance, craft materials, and adult education materials:
- Adult (21+ years) $185
- Youth (8 - 20 years) $105
- Children (4 – 7 years) $45
- Under 4 years $10
The Parish is willing to help subsidize the cost for larger families if there is financial need.
Do you require the large family cap of $500?
- Yes
- No
Would you like to make a tax-deductible donation to the Camp Trinity Scholarship Fund?
- Yes
- No
Donation amount
Would you like to request scholarship assistance to help pay for your registration fee?
- Yes
- No
Please enter the scholarship amount you are requesting.
Your request will need to be approved.
Total price
Adjustments such as the large family cap and financial aid requests will need to be approved.
Deposit charge
There is a nonrefundable deposit of $75 at time of registration. Your remaining balance is due on September 3. Adjustments such as the large family cap and financial aid requests will need to be approved. If you have requested an adjustment and have chosen to pay by check, simply send your $75 deposit at this time. We will notify you with your remaining balance.
- Pay now using your credit card ($75 + 3% fee = $77.50)
- Send in a check ($75, no fee)
You may mail payment to:

Chris Kehoe
Holy Trinity Catholic Church
3513 N Street NW
Washington, DC 20007

You may send one check for the full amount, or two separate checks (one for $75 that will be processed immediately, and one dated September 3, 2013 for the remaining balance). Your registration will not be confirmed until after your deposit is received by Holy Trinity.
Billing address*
Street AddressAddress Line 2CityStateZIP Code
This page is unsecured. Do not enter a real credit card number. Use this field only for testing purposes.
Credit card*
American Express
Discover
MasterCard
Visa
Card NumberExpiration Date Security CodeCardholder Name
Balance to be charged on September 3rd, 2013 (you will be invoiced or notified)
Adjustments such as the large family cap and financial aid requests will need to be approved. No refunds will be made after September 3rd, 2013
Name
This field is for validation purposes and should be left unchanged.

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Camp Trinity Registration Form

2013 Camp Trinity Registration Form

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Second Adult Information

Section Break

Child #1

Child #1 Information

Child #2

Child #2 Information

Child #3

Child #3 Information

Child #4

Child #4 Information

Child #5

Child #5 Information

Child #6

Child #6 Information

Child with non-present parent

Section Break