Mary, Star of the Sea Summer Extravaganza!
Summer Extravaganza 2017
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Email *
Student Information
Student Name *
Mailing Address *
City *
State *
Zip *
Home Phone *
Date of Birth *
Gender *
Required
Parent 1 *
Parent 1 Cellular *
Parent 1 email *
Parent 2
Parent 2 Cellular
Parent 2 email
Current School *
Allergies *
Required
Other Conditions (please include physical limitations)
Physician's Name and Contact Number *
Emergency Contact and Relationship *
Emergency Contact Number *
Class Selection
Please specify your summer school selections below: *
Required
Session 1 (Please specify from the following classes) *
Session 2 (Please specify from the following classes) *
Payment Options
Please hand deliver or mail (Mary, Star of the Sea School, 4469 Malia St. Honolulu, HI, 96821)  your summer school payment by no later than Friday, March 18, 2016.  
How will you deliver your payment *
Summer School Payment will be in the amount of *
A copy of your responses will be emailed to the address you provided.
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