Enrollment Form

Participant Name

First Name

Last Name

Parent/Guardian #1 Name

First Name

Last Name

Parent/Guardian #1 Email

Parent/Guardian #1 Phone

(###)

###

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Parent/Guardian #2 Name

First Name

Last Name

Parent/Guardian #2 Email

Parent/Guardian #2 Phone

(###)

###

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Check grade level participant is entering:

PreK 3

PreK 4

Kindergarten

First Grade

Week One

Superheroes and Princesses

Week Two

Summer is Sweet

Week Three

Stars and Stripes

Week Four

We love the beach!

Week Five

Christmas in July

Week Six

Sports Week

Week Seven

Under the Sea

Week Eight

Rainforest

Please list known allergies. If none, please write N/A.

I give the following adults permission to pick up my child from Summer at St. Patrick School.

Please list two.

Emergency Contact #1

Please list Name, Phone number and Email.

Emergency Contact #2

Please list Name, Phone number and Email.