Location Information

  • St. Therese's Camp
  • 7180 E. Twin Lakes Dr., Wasilla, AK, 99654 US

CAMPER Information

PARENT/Guardian Information

1. This form MUST be completed by a PARENT OR GUARDIAN.

2. All correspondence will be sent to this email address from ***. 

Emergency Contact Information

Please supply an Emergency Contact that does not live with you.

Camper Details

Cabin mate requests will be honored to the best of our ability.  Campers must be in the same grade band (3-5 or 6-8) and be the same sex in order to be cabin mates.

Dietary Restrictions

Health Information

Please verify that your children's tetanus shots are up to date before they come to camp.

For the safety of your child, please list details about any allergies in the box below

General Liability Release

d/b/a St. Therese’s Camp.


I, on behalf of myself and my minor dependent(s), hereby agree to the following for the attendance at St. Therese’s Camp (“Camp”) by my minor dependent(s):

1. Attendance at Camp may involve a variety of activities including but not limited to physical activities, hiking, boating and other activities, both indoors and outdoors.

2. My minor dependent(s) agrees to abide by all rules and regulations which apply to all participants at Camp programs.

3. My minor dependent(s) understands that the Camp rules follow from the Camp's Statement of Faith and that fighting, obscene language, sexual impropriety, use and/or possession of tobacco, alcohol, marijuana, illegal drugs or weapons of any kind (including pocket knives, leatherman or any similar tools) are not acceptable and may be grounds for terminating my minor dependent(s) time at Camp. In particular, I understand that if my minor dependent(s) violate any Camp rules, I may be asked to pick-up my minor dependent(s) or have them transported to me at my expense.

4. I understand that enforcement of Camp rules is subject to the sole discretion of the staff of Camp and that early termination of my minor dependent(s) participation in Camp activities for violation of Camp rules and regulations is not appealable.

5. I understand and grant permission for my minor dependent(s) to attend and participate in all activities held at Camp. In the case of a medical emergency, I understand that every effort will be made to contact the emergency contacts noted below. If Camp personnel cannot contact any of the emergency contacts or if the contacts don’t respond in a timely manner, I hereby grant permission for my minor dependent(s) to be evaluated, diagnosed and/or medicated in accordance with standard medical practice by licensed medical personnel. I agree to accept and assume any and all financial responsibility as a result of any treatment for such medical emergency.

6. In consideration for being permitted to access and use Camp facilities and to participate in the programs and activities sponsored by the Camp, I, on behalf of myself, my minor dependent(s), our heirs, successors and assigns, do hereby forever release and discharge Camp, its owners, officers, employees, agents, assigns and successors from all claims, demands, causes of action, lawsuits and liability for any injury or damages of any nature whatsoever, including death, incurred while using Camp’s facilities or equipment or while participating in any Camp sponsored activity.

6.1 Included in the foregoing waiver and release of claims are those injuries, deaths or damages arising from alleged negligent acts or omissions on the part of the Camp, its officers, employees or volunteers.

7. Further, in consideration of the use of Camp facilities and participation in activities and programs sponsored by Camp, I release and discharge Camp from any claim for personal property damage or for lost or stolen personal property in or about Camp, or in lockers, cabins or other similar places or for loss or damage to any property including but not limited to automobiles and contents thereof while on Camp premises.

8. I understand and agree that my minor dependent(s) and/or their work may be photographed or recorded during their time at Camp. I grant permission for photographs and recordings to be featured on the Camp’s website, displayed at Camp or included in promotional materials or reports.

9. I understand that respiratory illnesses such as the cold, the flu, and COVID-19 can be spread through group activities. I accept that risk for myself and/or my child as a condition of being permitted to participate in programs and activities sponsored by the camp.

10. I hereby represent that I am the parent, natural guardian or legal guardian of the minor dependent(s) listed below and, in such capacity, agree to defend, indemnify and hold harmless each of the parties referred to above from all liability, loss, claim or damage whatsoever which may be imposed upon the parties because of any defect in or lack of my capacity to so act and I hereby release the parties on behalf of my minor dependent(s).

Donation Opportunities

Thank you for supercharging St. Therese's with your financial gifts!

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Optional Merchandise

  • Sweatshirt



Billing Information

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  • American Express
  • Discover
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