Summer Program Registration 2012

1. Registration Form - Math and Science Summer Enrichment Program

Please fill out the following registration form completely. A separate registration is required for each child attending. A $25 dollar weekly non-refundable registration fee is due for each week your child is enrolled in the program. This fee will hold your child’s spot in the program. Please make all checks payable to: St. Paul Catholic Schools Consortium. An additional $125 will be due before your child will be allowed to attend the program. Payments cannot be made on site at the program. Payments must be mailed to: St. Paul Catholic Schools Consortium, Diocese of Worcester, Catholic Schools Office, 49 Elm Street, Worcester, MA 01609. Please note that your registration is not complete until full payment is received.

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1. Student's first name

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2. Students last name

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3. Student's date of birth (XX/XX/XXXX)

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4. School currently enrolled in

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5. Grade student is entering in the Fall (please enter a number)

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6. Parent first name

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7. Parent last name

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8. Street address

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9. City

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10. State

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11. Zip Code

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12. Parent Primary Phone (ten digit as 1234567890, no dashes).

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13. Parent Secondary Phone (ten digit as 1234567890, no dashes).

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14. Other Phone Number(ten digit as 1234567890, no dashes).

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15. Parent email

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16. Physical considerations (i.e. food allergies, etc.)

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17. I authorize use of my child's photograph(s) in St. Paul Catholic Schools Consortium marketing materials.

Yes

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18. Please indicate which week(s) your child would like to attend:

Week One: Lego My Robot! - Investigations: July 9 - 13

Week Two: Love That Dirty Water! - Ecology: July 16 - 20

Week Three: Shape Up! - Fitness and Nutrition: July 23 - 27

Week Four: I Got the Power! - Alternative Energy: July 30 - August 3

Week Five: If You Can't Stand the Heat - Fire Investigation: August 6 - 10

Please make all checks payable to: St. Paul Catholic Schools Consortium and mail to:
Diocese of Worcester
Catholic Schools Office
49 Elm Street
Worcester, MA 01609
(508) 929-4317
Registration is not complete until full payment is received.