Camper InformationStudent Name* First Last Grade Level*For the 2021-2022 school yearFourthFifthSixthSeventhEighthSchool Currently Attending*Student T-Shirt Size*Youth SYouth MYouth LYouth XLAdult SAdult MAdult LAdult XLWhat week(s) will camper be attending?* Week 1: June 7-11 Week 2: June 14-18 Parent/Guardian InformationParent/Guardian Name* First Last Phone Number*Email Address* Week 1: June 7-11Session 1:8-10 a.m.Turn the Beat Around - $100Creative Drawing - $125Session 2:10:30 a.m. -12:30 p.m.Pinterest Crafts - $100Coding with MicroBit - $100Session 3:1-3 p.m.Flag Corps 101 - $100Pottery - $135Session 1:8-10 a.m.Debate Camp - $100Creative Drawing - $125Pinterest Crafts - $100Session 2:10:30 a.m.-12:30 p.m.Digital Art 101 - $125Turn the Beat Around - $100Speech Camp - $100Session 3:1-3 p.m.Coding with MicroBit - $100Pottery - $135Flag Corps 101 - $100Week 2: June 14-18Session 1:8-10 a.m.Flag Corps 101 - $100Decorative Doorhangers - $125Session 2:10:30 a.m.-12:30 p.m.Pinterest Crafts - $100Coding with Sphero Mini - $100Session 3:1-3 p.m.Turn the Beat Around - $100Paint the Town (Creative Painting) - $125Session 1:8-10 a.m.Decorative Doorhangers - $125Flag Corps 101 - $100Session 2:10:30 a.m.-12:30 p.m.Turn the Beat Around - $100Glass & Jewelry - $150Forensic Science: Marian CSI - $100Session 3:1-3 p.m.Coding with Sphero Mini - $100Paint the Town (Creative Painting) - $125Pinterest Crafts - $100Total $0.00 Payment InformationCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name Billing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parental ConsentBy submitting this form, I hereby authorize the staff of the Marian Summer Camps to act for me according to their best judgment in any emergency requiring medical attention, and I hereby waive and release the school and all teachers involved for any liability and for any injuries or illness incurred while at Marian High School. I have no knowledge of any physical impairment that would affect the student named above on the information and registration form. Furthermore, I give Marian High School permission to take video or photographs of my daughter at the camps and use her image or likeness in future promotional materials.Submission InstructionsPlease do not click "Submit" more than once, or your card may be charged more than once. When a form has been successfully processed, a confirmation page will appear on this screen. You will also receive a confirmation email.