Apply for scholarship Camper’s registration form Camper's First Name *Camper's Last NameCamper's date of birth *MonthSelect month123456789101112DaySelect day12345678910111213141516171819202122232425262728293031YearSelect Year212521242123212221212120211921182117211621152114211321122111211021092108210721062105210421032102210121002099209820972096209520942093209220912090208920882087208620852084208320822081208020792078207720762075207420732072207120702069206820672066206520642063206220612060205920582057205620552054205320522051205020492048204720462045204420432042204120402039203820372036203520342033203220312030202920282027202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925Camper's phoneCamper's phone (optional)Gender *MaleFemaleStreet Address *Apartment, suite, etcCityState/ProvinceZIP / Postal CodeYour Parish *Parent/Guardian name *Parent/Guardian nameParent/Guardian Email Address *Parent/Guardian Email AddressParent/Guardian Phone *Parent/Guardian PhoneEmergency contact name *First and last name of the emergency contactEmergency contact email address *Emergency contact email addressEmergency contact phone *Emergency contact phoneSunscreen / Bug sprayCamp staff can apply sunscreen/bug spray to your childyour child is only allowed to use his/her own sunscreen/bug sprayWe will remind all campers to wear a hat, use sunscreen and possibly bug spray for outside activities. Please let us know if you don't want your child to use sunscreen or bug spray or if your child is only allowed to use his/her own sunscreen/bug spray.Health/Allergiesplease let us know of any health issues/allergies. Please note that this information will be shared with camp nurse and camp volunteers to make sure we keep our campers safe.Special Dietplease let us know of any health issues/allergies. Please note that this information will be shared with camp nurse and camp volunteers to make sure we keep our campers safeMedia release *We will be taking pictures during camp activities to keep the good memories. Please mark the checkbox as a permission for the photos of your camper. Parents will receive a link to download the camp pictures. Travel arrangementsDoes the camper need any special travel arrangements (for e.g. pick up from the airport)? Please let us know here, we will do our best to help, but it's not guaranteed.Comments / QuestionsHealth and Rope Course forms * Fill out health and rope course forms on Camp Copass website (link here) (you will need to create a parent account there) Check the box that health and rope course on Camp Copass website are filled out. St. Jonah Camp - Consent and Liability Waiver Form *Presented by the Russian Orthodox Church Outside Russia - Diocese of Chicago and Mid-America Completion of this form by a parent or legal guardian is a mandatory prerequisite for the attendance of any camper under the age of 18. I, the parent of above-mentioned child, authorize my child to participate in the St. Jonah Camp 2024, sponsored by the Youth Committee of the Diocese of Chicago and Mid-America (ROCOR). In consideration of the attendance of my child at the above named activity by the Diocese of Chicago and Mid-America, and for allowing my child to participate in this activity, I do hereby release and discharge the Diocese of Chicago and Mid-America, and all of its Pastors and adult leaders acting officially or otherwise from any and all claims, demands, actions, or causes of action on account of any injury sustained by my child during said above named activity. I hereby authorize any Pastor or adult leaders of the Diocese of Chicago and Mid-America to obtain emergency medical treatment for my child at any time during the above named activity. I understand that an attempt will be made to notify the parents first. If the parents are not available, however, the youth will be taken to the emergency room at the nearest hospital as circumstances may warrant. If any conduct of the participant warrants them to be excused from participation in the event, I assume all responsibility for disciplinary action and picking up my child upon being notified by the Pastor/adult leader. Should it be necessary for the participant to return home due to medical reasons, disciplinary action or otherwise, I hereby assume all transportation costs. I, the undersigned, hereby acknowledge that I have read the foregoing, understand its contents, and have signed the same as my own free act and deed. 03/12/2025Upload Waiver *Choose FileNo file chosenDelete uploaded filePlease download the waiver from this page, scan it and then uploadPayment *Full tuition ($475)First time camper at St Jonah Camp - $435 ($40 discount)Received 20% scholarship ($380)Received 50% scholarship ($237.50)Received 80% scholarship ($95)Payment method *Pay by credit card (+2.9% Stripe transaction fee)Pay by ZellePay by check in personPlease select your payment method. PAYING BY ZELLE or check will avoid paying stripe feesTotal registrationTotal registrationCredit / Debit Card *Zelle Payment to (281) 220-7599 *Please Zelle the total amount to phone (281) 220-7599 [ST JONAH ORTHODOX CHURCH] and enter the Zelle Payment/Confirmation IDPay by check in person at St Jonah Orthodox Church and enter here check number *Please make check payable to "St Jonah Orthodox Camp" Register 2_Campers_Diocese_WaiverDownload