Patriot Camp 2018 Registration Form - Paxtang


REGISTRATION IS CLOSED!!
This is the registration page for the PAXTANG PATRIOT CAMP, running June 25 through June 29, 2018 from 9:30 to noon.
Camp will be held at Saussaman Park, at the corner of Simpson Road and Wilhelm Road, just off Paxtang Avenue.

WE ALWAYS HAVE MORE KIDS REGISTER THAN WE CAN ACCOMMODATE. YOU WILL GET AN EMAIL AFTER THE DEADLINE TO LET YOU KNOW WHETHER WE COULD FIT YOUR KIDS.

Registration will open on April 16. Please do not try to register before April 16, as we may still be making changes to the registration page.

Please use this form to register for Campers (entering 1st through entering 5th), Patriots (entering 6th through entering 8th), and Volunteers for PAXTANG PATRIOT CAMP. You must fill out a separate form for each person being registered. Unless otherwise noted, please answer all questions. You will NOT get an immediate automated registration confirmation. You will get an email confirming your registration after registration closes at the end of May.

Please note - While we would love to be able to accommodate everyone, in order to maintain program quality, we must limit the number of participants to approximately 60 Campers (entering 1st grade through entering 5th grade) and 30 Patriots (entering 6th grade through entering 8th grade).

We can offer this camp because of our wonderful volunteers. Prior to 2017, when we were full, we cut based on date of registration. Now we will give priority to Campers and Patriots who have a family representative who can help with camp.

If you have questions, please email Deb Seneca at dseneca@kiix.com

We look forward to seeing you at Patriot Camp 2018 in Paxtang, Pennsylvania!

REGISTRATION FOR PATRIOT CAMP 2018 IS CLOSED!!!

Volunteer Availability

We will give registration priority to kids who have a family representative who can volunteer at camp. The family representative can be a parent, grandparent, teenage sibling, other relative, babysitter, or family friend - there are many options! Adults are especially needed. Please check below whether you will have an adult or a teenage volunteer, or if you cannot provide a volunteer.

Once you have registered your kids, please enter a separate registration(s) for the volunteer(s) associated with your family. When you register the volunteer(s), please choose the last option.

If your family cannot provide a volunteer, please write N/A in this space.

If your family has BOTH an adult and a teen volunteer, please check the availability for the adult.

Use the above box to explain your volunteer situation and availability.

Camper, Patriot, or Volunteer Name and Address

Please enter the following information for the person you are registering. You will need to submit a separate form for each person you want to register.

If you chose "Other", above, please write in the municipality.

What school will the camper, patriot, or volunteer attend in the fall?

If you chose "Other", above, please write in the school name.

Camper, Patriot, or Volunteer Information

Are you registering for a Camper, a Patriot, or a volunteer? Campers must be entering 1st grade through entering 5th grade. Patriots must be entering 6th grade through entering 8th grade. Volunteers must be entering 9th grade through adult.

Campers and Patriots should select the grade they will be entering in the fall. Youth volunteers (under 18 as of June 25, 2018) should select their age as of June 25, 2018, and volunteers (18 and over as of June 25, 2018) should choose "Adult". Please note - due to the change in PA law in July 2015, all adult volunteers will need to complete background clearances or show current clearances from other volunteer/paid activities. Adult volunteers will be contacted and given instructions.

Does the person you are registering have any allergies, health issues, or other issues that our staff needs to understand? If so, please list/explain them in the box below. If none, please type "None".

What size T-shirt would you like? I've noticed T-shirts from other teams/events running small lately. To be safe, maybe order a size up. T-shirts are $10 and proceeds help offset our costs. Checks should be made out to "Deborah Seneca". Payment must be received by June 1 in order to receive a t-shirt. Please send your payment as soon as possible along with your name to:

Deborah Seneca
515 Park Terrace
Harrisburg, PA 17111

If you would like to order additional t-shirts, please tell us the number and sizes in this box. See the pull down box above for sizes. Shirts are $10 each and 2XL/3XL are $12 each.

Parent/Guardian Information

Please enter information for the parents/guardians of Campers, Patriots, and Youth Volunteers. Adult Volunteers should enter their own name.

Emergency Contact Information

Please enter information for an emergency contact.

Paxtang Borough Independence Day Parade

The Borough of Paxtang is holding an Independence Day Parade on July 4 at 10 am. The Patriot Camp staff would like to enter a group of Patriot Camp kids and parents in the parade. Please indicate whether the registrant will be able to participate.

Photo Release

I hereby authorize the Borough of Paxtang, Patriot Camp, and Patriot Camp staff to use, reproduce, and/or publish all written and/or visual materials, including photographs and video that may pertain to me or my children. I understand that this material may be used in various publications, public affairs releases, recruitment materials, or for other related endeavors. This material may also appear on the Paxtang Borough or Patriot Camp Internet Web Pages and/or Facebook pages. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, the Borough of Paxtang, Patriot Camp or Patriot Camp staff may publish materials, use my name, my child's first name, photographs, video, and/or make reference to me or my child in any manner that the Borough of Paxtang, Patriot Camp, or Patriot Camp staff, deem appropriate in order to promote/publicize the event/program.

If you are registering an adult, please write "N/A" for the Parent/Guardian Name space above.

Liability Waiver

If you are the parent/guardian of the registrant, please read the following waiver of liability. Checking "I agree" constitutes your legal waiver as written.

I certify that I am the parent or legal guardian of the registrant, and the registrant has my permission to participate in Patriot Camp 2018. I certify that my child has adequate accident insurance and I will not hold Paxtang Borough, Paxton Presbyterian Church, or the Patriot Camp leaders/staff liable for any and all claims related to participation in this program.

If you are the adult volunteer registrant, please read the following waiver of liability. Checking "I agree" constitutes your legal waiver as written.

I certify that I have adequate accident insurance and I will not hold Paxtang Borough, Paxton Presbyterian Church, or the Patriot Camp leaders/staff liable for any and all claims related to participation in this program.

In the space below, please type the name of the person who filled out this form, including the Waiver of Liability section.