CAMP MAGIS
Application Form

Please print or type your answers and mail this form along with the $125 registration fee to:

Creighton Preparatory School
Attn: Camp Magis
7400 Western Avenue
Omaha, NE 68114

The information will be kept confidential.

Name of Applicant:  
Applicant's Adult T-Shirt Size:  
Date of Birth:  
Home Address:  
City:   State:   Zip:  
School:   Current Grade:  
Father's Name:  
Mother's Name  
Father's Place of Employment:  
Mother's Place of Employment:  
Number of Dependants:  
Home Phone:   Parent's Work Phone:  
Which of the choices below best describes your racial, ethnic and/or cultural background? 
(Check all that apply, or if necessary, write a description under “Other”.)
  African/African-American/Afro-Caribbean   Caucasian (white)
  Asian/Asian-American/Pacific Islander   Hispanic/Latino/Mexican
  Native American    Other Please Specify    
 
Please check where these apply:
  Parents are separated   Parents are divorced  
  Boy lives with both parents   Boy lives with mother   Boy lives with father
  Father is deceased   Mother is deceased   Boy lives with Guardian
 

 


 Does your child have allergies?  
If yes, to what? _______________________________________________________________
Describe allergic reaction: _______________________________________________________________
 
Any special problems of which we should be aware? _______________________________________________________________
Are there any sports/activities in which he cannot participate? _______________________________________________________________
   

In the event that my consent is not readily obtainable, permission is hereby given to the officials of Creighton Preparatory School to authorize such medical treatment, including an emergency operation, as they may be advised is necessary for my son.  I realize that the financial responsibility for such treatment or surgery is mine.

For the Student Applying:
I promise to be present every day and will arrive on time.
I promise to be on my best behavior.
I promise to attend the full  week.
Student signature: ____________________________________________

For Parents or Guardians:
I would like my son to attend Camp Magis and will see that he is present each day on time (8:45).
I promise I will allow my son to attend the full week.
I understand that my son can be dismissed for misbehavior.
 Parent/Guardian signature: ____________________________________________

Camp Magis is a one week program. We will offer two sessions. Please number in order of preference the week you would like your son to participate. (for example: 1 is your first preference, 2 your second preference).

Due to the high number of applications, we cannot promise to give you your first preference. We will try our best to accommodate your choice.
 
  July 9 – July 13   July 16 – July 20

 

* Please enclose your check for $125.  Please contact Bill Kleber at 393-1190 Extension 434  if you would like to discuss payment options.