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.
Student Name (First and Last
Saint Adalbert Catholic School
Most recent grade level completed:
Parent Name (first and last)
Current Mailing Address
Primary Phone Number:
Work Phone Number:
Additional Parent Phone Number:
Subjects or Areas of Need (check all that apply)
ELA (reading, phonics, english)
Session Preference: (choose 1)
8:00 am - 10:00 am
10:30 am 12:30 pm
Both sessions (8:00 am - 12:30pm)
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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This form was created inside of St. Adalbert Catholic School.