St. Ann Summer Catechesis Registration Form

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July 22-26, 8:30 am to 12:15 pm

Program for 4 yrs old (potty trained) through rising 5th graders

Fill out one form per family please.

Email *

Family Name *

Home Address (full address) *

Mother's Name

Cell/Work Phone

Father's Name

Cell/Work Phone

Home Phone

Emergency Contact (with phone number) *

Children

Please list children 4 years through 5th grade participating in the program

Child 1

First AND last name please

Birthdate

YYYY

Rising Grade

Child 2

First AND last name please

Birthdate

YYYY

Rising Grade

Child 3

First AND last name please

Birthdate

YYYY

Rising Grade

Child 4

First AND last name please

Birthdate

YYYY

Rising Grade

Child 5

First AND last name please

Birthdate

YYYY

Rising Grade

Allergies and Conditions

allergies, asthma, diabetes, other concerns. All children MUST be potty trained.

Other Notes

Please help us give your child the best experience possible. If your child needs any special attention, please note it here. Examples are trouble leaving parent at start of day, extra attention needed, trouble paying attention, Special needs, etc.

Adult Helpers Needed

May we contact you to help with the Summer Catechesis?

Yes

Not this year.

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Questions?

For questions, please contact us at SumCatStAnn@gmail.com

Registration Fee

Cost: $50 for 1 camper, $90 for 2, $125 for 3 or more in one household and includes all snacks and supplies.

Online payments should be made through the online link for "Summer Cat". If you pay in person, Make payments to St. Ann Catholic Church with Summer Catechesis in the notes.

Agreements and Waivers

By clicking submit, I am allowing my children to participate in the Summer Catechesis program at St. Ann. My children are allowed to be photographed for use by the church only. My children will be expected to follow directions and show respect to all involved as well as all church property while at Summer Catechesis.

Submit

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