CatCH Program Registration
Session 3 Offerings: January 6- February 20
(Course offering descriptions were sent in a previous email and are also available at
and on Facebook at Catamount Community Hours Afterschool Program)
Student Name and DOB
Grade and Teacher
Parent Name(s) and Phone Number (s): Cell, Work, Home
Emergency Contacts should Parent not be able to be reached- please complete if information has changed or not previously provided for prior sessions. (PLEASE INCLUDE: NAME, RELATIONSHIP TO CHILD, and PHONE NUMBERS)
Does your child have any allergies or other medical or special needs? Please Specify
Is your child on an IEP or 504 plan during the school day?
Is your child being provided with a one on one during the school day?
How will your child get home after programming each day?
Parent/Caregiver Pick Up (5:00 pm)
Bus (If Bus, please select the appropriate bus stop below)
5:05 Green Street
5:05 Maple Street
5:08 Family Dollar
5:10 St. J Academy
5:10 School & Pleasant
5:12 ABC LOL
5:13 South Main to end
5:15 Caldonian Street to end
5:15 Mtn View & Rte 5
5:16 Elm & Harris
5:16 Stetson Terrace & Rte 5
5:17 Concord & Harris
5:18 Post Office St J Center
5:19 Concord Ave to Lincoln Street
5:20 Green Lantern Trailer Park
5:25 Mount Pleasant Trailer Park
5:25 Riley's Fish Shack
5:30 Severance Hill
Please select the Monday/Wednesday course your child will participate in. (see registration packet for course descriptions)
Winter STEAM Adventure (Science Technology Engineering Art and Math) - Grades 1&2
Reader's Theater (Literacy)- Grades 1&2
Math Adventures- Grade 1&2
CatCH Skills: Basketball Clinic- Grades 1-3
Great States - Grades 3-5
Novel to Film Exploration (Literacy)- Grades 3-5
Fact Frenzy (Math) Grades 3-5
Please select the Tuesday/Thursday course your child will participate in.
Awesome Oceans - Grades 1&2
Destination Imagination- Grades 3-5
Please select if you would like your child to attend Fun Fridays during Session 3
I give permission for CatCH Program Staff to photograph/video my child during program activities or fundraisers. (Photos or videos will be displayed in our school, and may be used in flyers shared with the community, as well as in our school, local newspaper, and CatCH Facebook page)
I give permission to CatCH Program Staff to take my child off of school grounds to participate in after school field trips. (Parents/Caregivers will be notified prior to field trip dates)
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of The St. Johnsbury School.