Mary Star of the Sea Summer School
June 24-July 12 8:30am-2:00pm
Monday-Thursday
No School July 4
Email address *
Student Information
First Name *
Your answer
Last Name *
Your answer
Address *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Grade Level 2019-2020 *
Parent/Guardian Information
Name and Relationship *
Your answer
Address *
Your answer
Phone Number *
Your answer
Emergency Contact
Other than Parent/Guardian
Name and Relationship *
Your answer
Phone Number *
Your answer
Health Information
Allergies *
Your answer
Health Insurance Provider Name & Address *
Your answer
Doctor's Name and Phone Number *
Your answer
Dentist's Name and Phone Number *
Your answer
Consent *
Required
Today's Date *
MM
/
DD
/
YYYY
Parent Name as Signature *
Your answer
Payment
$325/ student
Please make payments (cash, check, credit card) to the MSSE office by June 19
Checks payable to "Mary Star Elementary"
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service