St. Ann Summer Catechesis Registration Form
July 17-21 8:45am to 12:15 pm
Program for 4 yrs old (potty trained) through rising 5th graders
Fill out one form per family please.
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Email *
Family Name *
Home Address (full address) *
Mother's Name
Cell/Work Phone
Father's Name
Cell/Work Phone
Home Phone
Emergency Contact (with phone number) *
Children
Please list children 4 years through 5th grade participating in the program
Child 1
First AND last name please
Birthdate
MM
/
DD
/
YYYY
Rising Grade
Child 2
First AND last name please
Birthdate
MM
/
DD
/
YYYY
Rising Grade
Child 3
First AND last name please
Birthdate
MM
/
DD
/
YYYY
Rising Grade
Child 4
First AND last name please
Birthdate
MM
/
DD
/
YYYY
Rising Grade
Child 5
First AND last name please
Birthdate
MM
/
DD
/
YYYY
Rising Grade
Allergies and Conditions
allergies, asthma, diabetes, other concerns. All children MUST be potty trained.
Other Notes
Please help us give your child the best experience possible. If your child needs any special attention, please note it here. Examples are trouble leaving parent at start of day, extra attention needed, trouble paying attention, Special needs, etc.
Adult Helpers Needed
May we contact you to help with the Summer Catechesis?
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Questions?
For questions, please contact us at SumCatStAnn@gmail.com
Registration Fee
Cost: $50 for 1 camper, $90 for 2, $125 for 3 or more in one household and includes all snacks and supplies.
Make checks payable to St. Ann Catholic Church with Summer Catechesis in the notes.
Please send check or drop it off in the off at St. Ann. c/o Virginia Blatchford.
Agreements and Waivers
By clicking submit, I am allowing my children to participate in the Summer Catechesis program at St. Ann. My children are allowed to be photographed for use by the church only. My children will be expected to follow directions and show respect to all involved as well as all church property while at Summer Catechesis.
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