Sacred Heart School
Sacred Heart Catholic Academy
Summer Camp Official Registration Due Friday, May 19, 2017 Limited Availability
Dates: July 3 through July 28 Ages: Nursery through Grade 6 Staff: Program staffed by SHCA Teachers College & High School volunteers
COST:
Times: Activities:
9:00 am to 1:00 pm Sports, Arts & Crafts, Games, Movies, Computer, Food Preparation Special Presentations
$85.00 per week per child (Due no later than 5/19/17) $25.00 Non Refundable Registration Fee per child (Due with this form by 5/19/17)
Complete the forms below and attached and return with your Registration fee no later than Friday, May 19, 2017. ------------------------------------------------------------------------------------------------------------------Sacred Heart Catholic Academy Summer Program Name of Student(s):
_______________________________________________ Grade: ____________ _______________________________________________
Registration Requested for the following: ( ) Week of July 3 ( ) Week of July 10
( ) Week of July 17
____________
( ) Week of July 24
( ) Registration Fee of $_____________ enclosed. (Due with this form by 5/19/17) ( ) Payment in the amount of $______________ enclosed. (Due 5/19/17) Parent’s Signature: _____________________________________________________
Sacred Heart Catholic Academy
Summer Program Information Form & Emergency Contacts Students’ Name:
Grade
Birth Date
__________________________________
________________
________________
__________________________________
________________
________________
__________________________________
________________
________________
Program Information: My child/children are enrolled for the following dates: ( ) Week of July 3
( ) Week of July 10
( ) Week of July 17
( ) Week of July 24
Parent Information Parent’s Name: _____________________________________________________________ Address:
_____________________________________________________________
Home Phone:
___________________________ Work: ___________________________
Cell Phone:
___________________________
Name and Phone number of those who are authorized to pick up your child. ________________________________________
__________________________
EMERGENCY CONTACTS – MUST BE COMPLETED List names and telephone numbers of those who are authorized to provide care for your child in the event you are delayed in arriving by 1:00 p.m. Name:
__________________________________ Phone: __________________________
Relationship: ______________________________ Name: ___________________________________
Phone: __________________________
Relationship: ______________________________ MEDICAL Allergies to food: ______________________________________________________________ Special Diet: ______________________________________________________________ Physical Activity: ______________________________________________________________ Parent’s Signature: ________________________________
Date: _____________________
Summer Camp Official Registration Due Friday, May 19, 2017 Limited Availability
Dates: July 3 through July 28 Ages: Nursery through Grade 6 Staff: Program staffed by SHCA Teachers College & High School volunteers
COST:
Times: Activities:
9:00 am to 1:00 pm Sports, Arts & Crafts, Games, Movies, Computer, Food Preparation Special Presentations
$85.00 per week per child (Due no later than 5/19/17) $25.00 Non Refundable Registration Fee per child (Due with this form by 5/19/17)
Complete the forms below and attached and return with your Registration fee no later than Friday, May 19, 2017. ------------------------------------------------------------------------------------------------------------------Sacred Heart Catholic Academy Summer Program Name of Student(s):
_______________________________________________ Grade: ____________ _______________________________________________
Registration Requested for the following: ( ) Week of July 3 ( ) Week of July 10
( ) Week of July 17
____________
( ) Week of July 24
( ) Registration Fee of $_____________ enclosed. (Due with this form by 5/19/17) ( ) Payment in the amount of $______________ enclosed. (Due 5/19/17) Parent’s Signature: _____________________________________________________
Sacred Heart Catholic Academy
Summer Program Information Form & Emergency Contacts Students’ Name:
Grade
Birth Date
__________________________________
________________
________________
__________________________________
________________
________________
__________________________________
________________
________________
Program Information: My child/children are enrolled for the following dates: ( ) Week of July 3
( ) Week of July 10
( ) Week of July 17
( ) Week of July 24
Parent Information Parent’s Name: _____________________________________________________________ Address:
_____________________________________________________________
Home Phone:
___________________________ Work: ___________________________
Cell Phone:
___________________________
Name and Phone number of those who are authorized to pick up your child. ________________________________________
__________________________
EMERGENCY CONTACTS – MUST BE COMPLETED List names and telephone numbers of those who are authorized to provide care for your child in the event you are delayed in arriving by 1:00 p.m. Name:
__________________________________ Phone: __________________________
Relationship: ______________________________ Name: ___________________________________
Phone: __________________________
Relationship: ______________________________ MEDICAL Allergies to food: ______________________________________________________________ Special Diet: ______________________________________________________________ Physical Activity: ______________________________________________________________ Parent’s Signature: ________________________________
Date: _____________________
