Sacred Heart Summer Program Application 2019
Spanish Immersion Program: PK3 -2nd grade STEM Discovery Program: 3rd - 8th grade


When: June 24th - July 19th, 2019

Where: Sacred Heart School: 1625 Park Rd. NW Washington DC, 20010

Who: Serving Students Rising into PK3 through 8th grade

Time: 8:15am - 3:15pm (Doors will open at 8:00)
Before care: 7:30-8:00 a.m.
**No after care program available**

Cost: $1,000 for a 4 week program - Weekly rate: $275
Before care cost: $50 (4 weeks)

Please note: The Early Childhood Spanish Immersion Program (PK3 - Kinder) is open to both Sacred Heart students and to the public.

*1st-8th grade summer programs are only available to Sacred Heart students.

Application deadline: May 1st, 2019

Please contact the office if you have any questions at 202-265-4828 or beverly.bonilla@catholicacademies.org

Email address *
Student Full Name (First & Last Name): *
Your answer
Permanent Address: *
Your answer
Student Date of Birth *
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Age *
Your answer
Gender *
Rising Grade for SY 19-20 *(1st -8th grade programs are only available to current Sacred Heart students)* *
Student will be attending: Cost: $1,000 for a 4 week program / Weekly rate: $275
Current School Attending *
Your answer
Parent/Guardian's Name (First & Last name) *
Your answer
Parent - Home Phone Number *
Your answer
Parent - Cell Phone Number *
Your answer
Parent - Work Phone Number *
Your answer
Emergency Contact #1 Name: *
Your answer
Emergency Contact #1: Phone Number *
Your answer
Emergency Contact #1: Address *
Your answer
Emergency Contact #2: Name *
Your answer
Emergency Contact #2: Phone Number *
Your answer
Emergency Contact #2: Address *
Your answer
Additional Transportation/Pick-up Individual: Name *
Your answer
Additional Transportation/Pick-up Individual: Relationship *
Your answer
Additional Transportation/Pick-up Individual: Phone Number *
Your answer
Child will depart camp by: *
Medical Information: Physician Name
Your answer
Medical Information: Physician Phone Number
Your answer
Does your child have asthma? *
Does your child have any known allergies: Yes or No? If yes, please specify. *
Your answer
Is your child part of the DC Kids Ride for Free Program (Smart trip)
Medical Release: In case of an emergency, the Sacred Heart School procedure will be to contact the parent at home or work. If unable to reach either parent, we will contact the next emergency contact listed. I will not hold the school financially responsible for any emergency care or transportation of said child *
Publicity Release: Sacred Heart School and the Archdiocese of Washington have opportunities throughout the summer to promote education through news stories in radio, TV, print and electronic media. Sacred Heart School has my permission to use my child’s photograph publicly to promote the school. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
Authorization for Field Trips: I/We, request that my son/daughter participate in short walking trips within walking distance of Sacred Heart School. I/We, understand that this request will enable my/our son/daughter to visit the following areas throughout the summer program: The Shrine of the Sacred Heart, Mount Pleasant Library, Mount Pleasant/Adams Morgan Area/ Rock Creek Park *
Would you like to register for before care? (7:30-8:00 a.m.) Cost: $50 (4 weeks). *
How would you like to pay? Note: In order to finalize the application process please visit/contact the office to make payment at 202-265-4828 Thank you! *
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