RegistrationForm

St. Michael’s

Summer Enrichment Program

Online Registration Form Grades K-8

Today’s Date:

Please Enroll My Child in:

Student's Name:

Grade (fall 2008):

Birthdate:

Age:

School Attended in 2007-2008:

Mother's Name:

Father's Name:

Home Address:

City:

State:

Zip:

Phone: (H)

Mother: (W)

Father: (W)

Mother: (C)

Father: (C)

In Case of Emergency Call: (Name)

Emergency Contact Numbers: (H)

(C)

Medical Conditions/ Allergies the Staff Should Be Aware of:

Course Selection(s):

Total Tuition:

Please make checks payable to "St. Michael's Summer Program". Checks must be postmarked within 3 business days of receipt of this Registration Form to validate the registration. Mail to:

St. Michael's Summer Program

602 N Wilmot Rd.

Tucson AZ 85711

Check Number:

VISA:

MasterCard:

Account Number:

Expiration Date:

Relationship to Child:

Please complete one form per student per Session.

$370 per Two Week Session (Fee Includes Extended Hours option)

Method of Payment:

Credit Card:

This page was last updated: March 5, 2008

Name of Card Holder As It Appears on Credit Card:

E-mail Address:

Gender:

Nickname:

(Please complete one form per student per Session.)

Early Registration:

Register online before April 15 and we will not process your payment until May 15.

$185 per Two Week Session (Fee Includes Extended Hours option)

$370 per Two Week Session (Fee Includes Extended Hours option)