Winter 2018 SJS Enrichment registration
Event Timing: January 29th-May 30th, 2016
Event Address: St. Joseph School, 39 Gebhardt Road
Contact us at
Please fill out only one child per form, but you may sign up for multiple classes on one form.
Email address *
Name of child *
Your answer
Name of child's teacher
Your answer
Grade of child *
Name of parent/guardian/contact *
Your answer
Phone number *
Your answer
Alternate email address
Your answer
Classes to register for: *
How does your child get home typically on the day of the class? (Parents must send a note each day of class.) *
Does your child have allergies? (Sometimes classes involve food - we want to make sure your child remains safe.) *
I request my student be enrolled in this(these) Enrichment Club(s). I understand these sessions are conducted by independent contractors. I understand the school’s insurance policy is still in effect for the duration of this activity. I hereby give my consent to have a first aid responder, EMT, nurse and or doctor provide my student with medical assistance and treatment. I understand I am responsible to pick up my student at the end time indicated above. If I fail to do so I understand that my student may be taken to the After School Care Program and I acknowledge I will be responsible for any and all associated fees related to my student’s attendance in this program. *
I am at the full understanding that participation in an after school activity may come with some risks. Sports, cooking, artwork, etc. have certain risk factors. By selecting yes, I assume risk of harm or injury which may occur to the participant as a result of participating in ANY of the St. Joseph’s Enrichment clubs, events or activities. I hereby release St. Joseph’s School, Church and its officers, employees, or agents from any liability, costs and damages resulting this individual's participation. I agree that the minor has my consent to participate in the event or activity. I also give my consent for St. Joseph’s School to seek emergency treatment for the minor if necessary, and I agree to accept financial responsibility for the costs related to this emergency treatment. *
I understand that I will have to send a check payable to St. Joseph School or the vendor listed for my registration to be finalized. I should send the check in an envelope marked enrichment. I understand that to apply for financial aid for this activity, I should contact the school principal. *
I understand that I need to pay a $20 registration fee to St. Joseph School once per school year per family to register for enrichment: *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms