After-School Program 2024-25 Enrollment Form

Saint Paul's Choir School After-School Program Sign-Up 2024-25 TERM 1

29 Mount Auburn Street, Cambridge MA 02138 (617) 868-8658
PROGRAMMING SELECTION:

Select your days and programs below.
After-School programs to be enrolled:

Monday through Friday, 3:30 - 5:00, Study Hall with SPCS Faculty, $100/termMonday & Friday, 3:30 - 5:00, Mandarin with Ms. Jin Wang, $300/termTuesday & Wednesday, 3:30 - 5:00, Acting Workshop with Ms. Tanya Wright, $500/termWednesday, 3:30-5:00, Chess Club with Mr. Winer, $300/termThursday, 3:30-5:00, Frassati Society with Ms. Amburn, $50/term
CHILD INFORMATION:
Child Name*

First NameLast Name
Grade*
Please type the grade your child entered in September 2021
PARENT/GUARDIAN INFORMATION:
Parent/Guardian 1 Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Alternate/Work Phone Number

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian 2 Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
MEDICAL INFORMATION
Allergies*
If none, type NO.
Allergy Medications & Plan*
Please indicate here which medications your child may require for his or her allergies. If your son or daughter has a prescription for an Epi-Pen or similar, we will require that one be kept onsite. Further, please advise if you have a doctor's written allergy plan; if so, we will require a copy. If none of this applies, type NO.
Medical Concerns (Non Allergy)*
Please include necessary medications and/or other health concerns that we should be aware of in providing care for your child. If none, type NO.
Primary Emergency Contact*

NamePhone Number
Secondary Emergency Contact*

NamePhone Number
Medical Care Release:

I hereby delegate authority to the educators Saint Paul's Choir School to arrange whatever medical treatment they deem necessary in an emergency (i.e. call 911) for my child during his participation in an after school program. Please type your name below as your digital signature.
Medical Care Release Signature*

First NameLast Name
Participation and Liability Waiver:

I hereby give permission for our son/daughter to participate in the above-selected after school activities conducted by SPCS. We agree to hold the directors and staff harmless from any liability to anyone on account of any injuries to our son. I understand that SPCS cannot be responsible for lost or broken items. I understand my son/daughter will comply with all program policies and procedures. I also understand, and will comply with, all cancellation policies and procedures. Please type your name below as your digital signature.
Participation and Liability Waiver Signature*

First NameLast Name
Contact Us:

(617) 868-8658 / pmoran@saintpaulschoirschool.us
Should be Empty:

Saint Paul's Choir School After-School Program Sign-Up 2024-25 TERM 1

PROGRAMMING SELECTION:

CHILD INFORMATION:

PARENT/GUARDIAN INFORMATION:

MEDICAL INFORMATION

Medical Care Release:

Participation and Liability Waiver:

Contact Us: