Saint Adalbert Summer Enrichment Program- Registration
Dates: June 21st- July 16th
Hours: 8:00 am - 12:30pm
Cost: $75 to be paid by June 18th
Breakfast and Lunch served daily

In- person attendance is required. Virtual learning will only be an option on a limited basis and requires approval of Mrs. Smith. Contact Mrs. Smith to discuss further.

Form must be complete entirely, including emergency contacts, for registration to be complete.
Email *
Student Name (First and Last *
School: *
Most recent grade level completed: *
Parent Name (first and last) *
Current Mailing Address *
Primary Phone Number: *
Work Phone Number: *
Additional Parent: *
Additional Parent Phone Number: *
Subjects or Areas of Need (check all that apply) *
Required
Session Preference: (choose 1) *
Emergency Contact 1: First and last name, relationship to child, phone number *
Emergency Contact 2: First and last name, relationship to child, phone number *
A copy of your responses will be emailed to the address you provided.
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