Step 1 of 2 50% Camper InformationCamper's Name(Required) First Last Birth Date(Required) MM slash DD slash YYYY Allergies/Food Allergies/Conditions/Medications:Villager Email(Required) Cell #Parents InformationMother's Name(Required) First Last Mother's Cell #(Required)Mother's Email(Required) Father's Name(Required) First Last Father's Email(Required) Father's Cell #(Required) Consent and Payment ProcessingGroup Transportation Deposit(Required) Price: I give consent for my participation and/or my (above) child’s participation in the Antiochian Village Camper session from July 27- August 8, 2025. I hereby absolve Saint George Antiochian Orthodox Church of Cicero, IL, the Antiochian Archdiocese, affiliate organizations, employees and representatives, of any liability in the event of accident or injury during my participation and/or my child’s participation in this trip. In addition, I understand I must notify the Church staff of any medical history which may cause any harm during my participation and/or my child’s participation in the program. I, also, grant permission for the appropriate use of any photographs, audio recordings, video images, or any other visual or audio reproduction that may be taken of myself and/or my child during this trip to be used in a video, website, social media, for promotional purposes of the program, or shown as Saint George Church sees fit. Furthermore, I understand only proper conduct and behavior befitting the Church will be allowed and disrespectful behavior may result in the dismissal of any person causing misconduct at the cost and responsibility of the said person. Please check the box below to accept consent liability form(Required) Yes, I agreeTotal Due:Please proceed to credit card section to pay this balance. Credit Card(Required)Card Details Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
