2018 Summer Late Night
We invite students to join us for the final Late Night of the summer.

Parents can enjoy a quiet night while we party with your children for four hours. We will entertain your children with some Late Night summertime fun! There will be plenty of games, crafts, and snacks to keep them happy and engaged for hours.

Children ages 5 and up are welcome!

Friday, July 20th

7:00 p.m. to 11:00 p.m.

$40 per child

Space is limited. Sign up today!

If you have any questions please email Mr. D and/or Germaine DiJohn at gdijohn@shma.us

Child's Name *
Your answer
Age *
DOB *
MM
/
DD
/
YYYY
Home Phone
Your answer
Parent (Guardian) Name *
Your answer
Home Address *
Your answer
Cell Phone *
Your answer
Email Address *
Your answer
Allergies or other health information *
Your answer
Emergency Contact 1 (Name & Number) *
Your answer
Emergency Contact 2 (Name & Number) *
Your answer
Late Night Fees
$40.00

Once this registration form is submitted an invoice will be emailed to you. Payment can be made by clicking on the payment link, or submitted to the office by cash or check.

Late Night registration isn't complete until payment has been received.

My child is enrolled in the SHMA Summer Camp *
If your child is NOT enrolled in the SHMA Summer Camp
If your child is NOT enrolled in the SHMA Summer Camp, you will need to submit two Emergency Medical Release Forms. (Please print two forms.) Both forms will need to be signed and notarized. Forms are required to be submitted to the office prior to Late Night. (One will be on file in the office and the other kept with staff.)

http://www.safetyharbormontessori.com/documents/EmergencyMedicalRelease_rev13.pdf

If your child is NOT enrolled in the SHMA Summer Camp
If your child is NOT enrolled in the SHMA Summer Camp, you will need to submit a School Entry Health Exam form and Florida Certification of Immunization form. Forms are required to be submitted to the office prior to Late Night.
Late Night
7:00 p.m. - 11:00 p.m.
Friday, July 20, 2018
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Required
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