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St. Francis Catholic Church
Summer Programs Registration Form 2015
Date: June 22-26
Time: 9:00 am- 12:15 pm
Vacation Bible School - Preschool through entering 5th grade
Child’s Name
Gender
DOB
Shirt Size
Grade - Fall ‘15
1.
2.
3.
Friend/Youth Guide Request: One friend or youth guide request per child.
Child 1:
Child 2:
Child 3-:
R
Middle School Summer Retreat
Child’s Name
Gender
DOB
Shirt Size
Grade
E
A
1.
C
2.
H
Parent/Guardian’s Name:
Day Phone :
Address:
*E-Mail Address:
*Communications (updates/reminders) will be sent by email. Please make sure it is current!
Allergies/Medical Concerns:
Emergency Contact Information
Name:
Phone:
Relationship to child:
Registration Fees
Summer Programs - VBS (4yrs-5th) & MSSR (6th-8th) …………..……..
1 child = $35; 3+ children = $95
VBS CD’s ……………………………………………………………………………………..
$8
Late Fee (after May 31st) …………………………………………………………...
Add $10 per child
I would like to help another family in need by donating:
TOTAL TO BE PAID
Payment must accompany the registration form.
Forms will not be processed until payment or other arrangements have been made.
Contact Violet Wanner at [email protected] with questions.