Totus Tuus

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mother's/Guardian's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's/Guardian's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Father's/Guardian's Name REQUIRED Please fill out this field. Please enter valid data.

Father's/Guardian's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Preferred Parent's Email Address REQUIRED Please fill out this field. Please enter an email address.

Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Relationship to Participants REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Camper Information

Campers REQUIRED Please fill out this field.
Child 1
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.
Child 2
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.
Child 3
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.
Child 4
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.
Child 5
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.
Child 6
- Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Please Indicate Known Food Allergies or Medical Information
- Child's Grade (that he or she will be entering in the fall of 2024) Please enter an integer (number).
- T-Shirt Size REQUIRED Please fill out this field.

Waivers and Digital Signature

I attest that the information above is correct, and I give permission for my child to attend Camp Totus Tuus at Prince of Peace Parish

I Agree Please select this field.

Payment

Do you understand that this Registration form is not finalized until payment has been made via GiveCentral or by cash/check payable to Prince of Peace (memo Totus Tuus) to the Parish office Click here to access the payment link

Note: When paying via GiveCentral, one payment is for the "Grade School Program" the other is for the "Junior High and High School Program". If you have campers in both programs, you will need to select each program seperately, add your choices to the cart, and pay them together.

I Agree Please select this field.

Liability Waiver

I, the parent and/or legal guardian, of the child(ren) registered by me, herby give my permission for his/her participation in Camp Totus Tuus. I agree to direct my child(ren) to cooperate and conform with directions and instruction of parish, school, and/or Diocesan personnel responsible for youth activities.
As the parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above named student. In consideration of my child being allowed to participate in this activity, I hereby release and agree to indemnify and hold harmless, the Archdiocese of Chicago, Prince of Peace Parish, teachers, chaperones, volunteers, or representatives associated with the event, and their employees and agents, from any liability for injuries, damages, medical expenses, or any other loss to my child, family, or me (including attorney’s fees) arising from or related to my child’s participation in this activity.

I Agree Please select this field.

Publicity Waiver

Video, still photographs, and audio recordings may be taken during Camp Totus Tuus. This authorization form constitutes permission for my child’s participation in videotaping, still photographs, and/or audio recordings, which may be used for future promotional efforts, including the Archdiocese of Chicago and/or St. John Newman Parish publications, websites, and advertising materials.
In addition, local news organizations may be allowed to photograph or record our events to be used, distributed, or displayed as agents of the parish and/or diocese as the parish and/or diocese see fit.
I hereby expressly grant to the parish named above and/or the Archdiocese of Chicago the right, privilege and license to use the picture or likeness of my child in any photograph, movie, video production or any other forms of media publication and to use the verbal or written statements or declarations of my child for the purpose of publicizing, fostering and promoting the parish and/or diocese and its programs, or for any other purpose in furtherance of the mission of the parish and/or the Archdiocese of Chicago.

Publicity Waiver REQUIRED I Agree I Disagree Please fill out this field.

Medical Waiver

I grant permission for the administration of First Aid to my child(ren) signed up for Camp Totus Tuus by the people in charge of the Totus Tuus event, to sign the necessary releases as may be required, and to make the necessary referrals to qualified physicians for the treatment of illness or accidents of a more serious nature.
I understand I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In the case of a medical emergency, I understand that every effort will be made to contact the parent/guardian of the participant firstly, then the emergency contact listed above when I cannot be reached. In the event that I cannot be reached, I hereby give permission to the physicians selected by the adult staff to hospitalize, secure proper treatment for, and to order injection, anesthesia, or surgery if deemed necessary for my child.

Medical Waiver REQUIRED I Agree I Disagree Please fill out this field.

Digital Signature REQUIRED

Legal Guardian over the age of 18.

Please fill out this field. Please enter valid data.

Prince of Peace Catholic Church

135 S. Milwaukee Avenue Lake Villa, IL 60046 (847) 356-7915

Totus Tuus

Totus Tuus 2024 Registration Prince of Peace

Registration Required