Saint Columbkille April Vacation Application 2020
The vacation program will be held from Tuesday, April 21- Thursday, April 24 from 8:00 AM to 5:30 PM.  Please note there will be no vacation program on Monday, April 20 and Friday, April 19.   This program is for students in Pre-K through grade 4.

The fee per child for the program is as follows:
2 Days - $140
3 Days - $210
4 Days - $280

Please note, all payments will be processed through the FACTS Payment Plan on Tuesday, April 21, 2020.

All applications are due by Friday, April 10th.

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Email *
Student First Name *
Student Last Name *
Grade Level *
Days Enrolled *
Please check off the days that your child will be attending: *
Required
Please choose one of the following: *
Parent/Guardian Name *
Home Phone Number
Cell Phone Number *
Work Phone Number
Parent/ Guardian Full Name *
Home Phone Number
Cell Phone Number
Work Phone Number
Emergency Contact Name *
Relationship To Student *
Cell Phone Number *
Emergency Contact Name
Relationship To Student
Cell Phone Number
Child's Allergies *
Chronic Health Conditions *
Child's Physician's Name *
Physician's Address *
Physician's Phone Number *
Health Insurance Plan *
Policy Number *
I authorize the staff in the Saint Columbkille Vacation Program who are trained in the basics of first aid to administer first aid and/or CPR to my child when appropriate. I understand that every effort will be made to contact me in the event of an emergency requiring medical attention for my child.  I hereby authorize the program to transport my child to the nearest medical facility and to secure medical treatment when I cannot be reached or when delay would be dangerous to my child’s health. *
I give permission for my child to take part in any and all of the activities planned by the staff of the Saint Columbkille Vacation Program.  It is agreed that no liability is assumed by the school, the parish, or school program staff for injuries to persons or damage to property while on these trips. In case of emergency, I give permission for my child to be treated by a physician. *
I give permission to the Saint Columbkille Vacation Program to photograph or videotape my child for use in its publications or other public relations materials (television, newspapers, brochures, posters, websites, etc.) to promote its services and program. *
A copy of your responses will be emailed to the address you provided.
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