Summer Knights Academy - Registration
Join your friends and fight the Summer Slide!

Mondays through Thursdays, July 2-26, 2018 (4 weeks)
+No School Wednesday, July 4th
+In Session Friday, July 6th
+Daycare Available 7-7:45am (complementary) and 3-6pm (small fee)

St. Joseph the Worker School
19812 Cantlay St. Winnetka, CA 91306
Contact us at (818) 341-6616 or Ms.Guilbault@sjwschool.net

Please complete one registration per student.

Email address *
Student Name *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Daytime Phone Number *
Your answer
Parent/Guardian Name
Your answer
Parent/Guardian Daytime Phone Number
Your answer
Address *
Your answer
Emergency Contact - Name *
Your answer
Emergency Contact - Phone Number *
Your answer
Emergency Contact - Relationship to Student *
Your answer
Present School Attending - 2017-2018 year *
Your answer
Grade (2018-2019 school year) *
Full Day or Individual Sessions *
Required
Learning Lab Session A choice - $150 *
Required
Learning Lab Session B choice - $150 *
Required
Enrichment Elective Session A choice - $150 *
Required
Enrichment Elective Session B choice - $150 *
Required
Knights Academy Daycare (3:00 - 6:00pm) - $250 *
Required
I understand that the $50 Summer Knights Academy registration fee is non-refundable. *
Required
Students registered by June 1st receive a Summer Knights Academy t-shirt. Additional shirts may be purchased for $15. Please indicate size and quantity below. *
Required
By submitting this form, I hereby grant my consent to have emergency medical treatment administered to my child at the discretion of the attending physician. *
Required
Are there any concerns (medical, allergy, or otherwise) that the school and teachers should be aware of? Please explain. *
Your answer
Please type your name and today's date below as a digital signature. *
Your answer
A copy of your responses will be emailed to the address you provided.
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