Summer Enrichment Program

Child's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

School your child currently attends REQUIRED Please fill out this field. Please enter valid data.

Current Grade (grade just completed) REQUIRED Please fill out this field.

Will your child be attending the Catapult Summer Program from 8:00am to 1:30pm? REQUIRED Yes No Please fill out this field.

Student's Gender REQUIRED Male Female Please fill out this field.

Any Food Allergies or restrictions REQUIRED Please fill out this field.

More than one child attending? REQUIRED Yes No Please fill out this field.

If Yes, please provide child's information

First Name Please enter valid data.

Last Name Please enter valid data.

Current Grade (grade just completed)

Will your child be attending the Catapult Summer Program from 8:00am to 1:30pm? Yes No

Student's Gender Male Female

Any Food Allergies or restrictions

Week your child(ren) will be attending program

Week 1 6/23 - 6/27 REQUIRED Yes No Please fill out this field.

Week 2 6/30 - 7/3 REQUIRED Yes No Please fill out this field.

Week 3 7/7 - 7/11 REQUIRED Yes No Please fill out this field.

Week 4 7/14 - 7/18 REQUIRED Yes No Please fill out this field.

Week 5 7/21 - 7/25 REQUIRED Yes No Please fill out this field.

Week 6 7/28- 8/1 REQUIRED Yes No Please fill out this field.

Week 7 8/4 - 8/8 REQUIRED Yes No Please fill out this field.

Week 8 8/11 - 8/15 REQUIRED Yes No Please fill out this field.

Week 9 8/18 - 8/22 REQUIRED Yes No Please fill out this field.

Week 10 8/25- 8/29 REQUIRED Yes No Please fill out this field.

Please indicate T-Shirt Size REQUIRED Youth Small Youth Medium Youth Large Youth Extra Large Please fill out this field.

MOTHER'S INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Cell Phone REQUIRED Please fill out this field. Please enter a phone number.

Mother's Work Phone REQUIRED Please fill out this field. Please enter a phone number.

Mother's Email REQUIRED Please fill out this field. Please enter an email address.

FATHER'S INFORMATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Father's Cell Phone REQUIRED Please fill out this field. Please enter a phone number.

Father's Work Phone REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Comments: (sample: we would like early drop off)

If school cannot contact parent or legal guardian, list friends or relatives of legal age who may be called upon if your child is sick. Also include the name(s) of any person who has your permission to sign for the early release of your child.

EMERGENCY CONTACT'S INFORMATION

Contact 1

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Contact 1 Relationship REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Contact 2

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Contact 2 Relationship REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.