St. Justin Super Chargers Summer Camp 2019
ONE FORM PER STUDENT

Please fill out the following form. Once completed, a PDF will be emailed to you. Please PRINT, READ carefully all the terms and policies, SIGN the highlighted areas and TURN IN to the school office. REGISTRATION IS NOT COMPLETED UNTIL A SIGNED FORM IS RECEIVED.

** St. Justin Families- Summer Fees will be taken from SMART Tuition account in June and July. First week fee and registration will be taken when application form is turned in. Once weeks are billed there will be NO REFUNDS. All Drop-In days will require payment the day of service and an emergency form must be completed for us to take the student.

**Non-St. Justin Families- Payment by check must be attached to the PDF form and paid a week in advance.

Student Information
Student's First Name *
Your answer
Student's Last Name *
Your answer
Home Address *
Street, City and Zip
Your answer
Home Phone Number *
Your answer
Grade Level in Fall 2019 *
Current Age *
Your answer
Date of Birth
MM
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DD
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YYYY
School Attending in Fall 2019 *
Your answer
Child Lives with... *
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