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Summer Camp 2026 Registration Form

Child 1

Enter Month/Day/Year EX: 12/05/2020

Child 1: Any allergy or medical condition
Yes
No
Is the child taking any medication on a daily basis?
Yes
No

NOTE: ST. Mary summer camp will NOT administer any medication but needs to be aware in case of an emergency.

Child 2

Enter Month/Day/Year EX: 12/05/2020

Child 2: Any allergy or medical condition
Yes
No
Is the child taking any medication on a daily basis?
Yes
No

NOTE: ST. Mary summer camp will NOT administer any medication but needs to be aware in case of an emergency.

Child 3

Enter Month/Day/Year EX: 12/05/2020

Child 3: Any allergy or medical condition
Yes
No
Is the child taking any medication on a daily basis?
Yes
No

NOTE: ST. Mary summer camp will NOT administer any medication but needs to be aware in case of an emergency.

Pickup Information

Write N/A if not applicable.

Emergency Contact

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St. Mary's Coptic Orthodox Cathedral

3405 N New Hope Rd,
Raleigh, NC 27604

(919) 878-4477

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