Sacred Heart Summer Program Application
Spanish Immersion Program: PK3 -2nd grade STEM Discovery Program: 3rd - 8th grade


When: June 25th - July 27th, 2018

Where: Sacred Heart School: 1625 Park Rd. NW Washington DC, 20010

Who: Serving Students Rising into PK3 through 8th grade

Time: 8:15am - 3:15pm (Doors will open at 8:00)

Cost: $1,000 for 5 weeks

Application deadline: May 31st

Please contact the office if you have any questions at 202-265-4828 or beverly.bonilla@catholicacademeis.org

Email address *
Student Full Name (First & Last Name): *
Your answer
Permanent Address: *
Your answer
Student Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Rising Grade for SY 18-19 *
Current School Attending *
Your answer
Parent/Guardian's Name (First & Last name) *
Your answer
Parent - Home Phone Number *
Your answer
Parent - Cell Phone Number *
Your answer
Parent - Work Phone Number *
Your answer
Emergency Contact #1 Name: *
Your answer
Emergency Contact #1: Phone Number *
Your answer
Emergency Contact #1: Address *
Your answer
Emergency Contact #2: Name *
Your answer
Emergency Contact #2: Phone Number *
Your answer
Emergency Contact #2: Address *
Your answer
Additional Transportation/Pick-up Individual: Name *
Your answer
Additional Transportation/Pick-up Individual: Relationship *
Your answer
Additional Transportation/Pick-up Individual: Phone Number *
Your answer
Child will depart camp by: *
Medical Information: Physician Name
Your answer
Medical Information: Physician Phone Number
Your answer
Does your child have asthma? *
Does your child have any known allergies: Yes or No? If yes, please specify. *
Your answer
Medical Release: In case of an emergency, the Sacred Heart School procedure will be to contact the parent at home or work. If unable to reach either parent, we will contact the next emergency contact listed. I will not hold the school financially responsible for any emergency care or transportation of said child *
Publicity Release: Sacred Heart School and the Archdiocese of Washington have opportunities throughout the summer to promote education through news stories in radio, TV, print and electronic media.Sacred Heart School has my permission to use my child’s photograph publicly to promote the school. I understand that the images may be used in print publications, online publications, presentations, websites, and social media. I also understand that no royalty, fee or other compensation shall become payable to me by reason of such use. *
How would you like to pay? Note: In order to finalize the application process please visit/contact the office to make payment. Thank you! *
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Catholicacademies.org. Report Abuse - Terms of Service - Additional Terms