Summer Fun Camp Registration Form

Summer Fun Camp is open to all St. Dominic Catholic School & Parish Families. The program runs from June 10-August 16, 2019.

(Please note: No sessions held the first 2 weeks of July due to the holiday and Dominic Days!)

Please complete this form to register your child(ren) to attend the 2019 Summer Fun Camp. There will be two sessions each day, morning and afternoon. Please state as accurately as possible

the sessions each of your children will attend per day.

Family Name ________________________ Home Phone (_____) __________________

Address ____________________________ City/Zip _____________________________

Father’s Name _______________________ Mother’s Name ______________________

Email ______________________________ Email ______________________________

Cell Phone (_____) ____________________ Cell Phone (_____) ____________________

Place of Employment

Father ________________________________________________________________

Phone # (_____) ___________________ Full Time □ Part Time □

Mother _______________________________________________________________

Phone # (_____) ___________________ Full Time □ Part Time □

__________________________________________________________________________________________

Child’s Name _________________________ Age __________ DOB ________________ M T W TH F

Number of Sessions: _______ ______ ______ ________ _______ __________________________________________________________________________________________

Child’s Name _________________________ Age __________ DOB ________________ M T W TH F

Number of Sessions: _______ ______ ______ ________ _______ __________________________________________________________________________________________

Child’s Name _________________________ Age __________ DOB ________________ M T W TH F

Number of Sessions: _______ ______ ______ ________ _______

My employer provides compensation for childcare expenses. Yes_____ No____

I will be paying the Summer Fun Program Fee: Monthly____ Bi-Weekly ____ Weekly____

A non-refundable registration fee of $20.00 per family is due with this form by April 26, 2019. After April 26, 2019, the fee is $35.00 per family.

Signature _____________________________________________________ Date _______________________

Please return this form with payment to: St. Dominic Catholic School, 18105 W. Capitol Dr. Brookfield, WI 53045