2023 Summer K-5 Enrollment Form

Emergency Contacts & Healthcare Information

You must list at least TWO emergency contacts authorized to take your child/ren from Community of Saints if parent(s) or guardian(s) cannot be reached. This may not include parent(s) or guardian(s) listed previously. Please make sure to list someone your child is comfortable leaving school with. If you are enrolling multiple children, we assume the information in this section is the same for all your children. If that is not the case, please contact us so we can update your information.
Emergency Contact 1*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Student*
Emergency Contact 2*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Student*
Emergency Contact 3

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relation to Student
Doctor*
Name of Office
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Dentist*
Name of Office
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Hospital*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Yes, I agree
Yes, I agree
Media Consent

I consent that Community of Saints School be permitted to use and publish for advertising, commercial or publicity purposes, the name and likeness of my child for any other lawful purpose whatsoever, including photographic portraits, pictures, reproductions, made through any medium, including electronic media, and the undersigned parent/guardian does hereby release Community of Saints School from any liability in connection with such use.

The undersigned parent/guardian acknowledges having read this release, having had the opportunity to consider and understand its terms and does hereby execute it voluntarily and with knowledge of its significance.

If you do not want your child’s picture on the school website or for any other marketing purposes, please talk to your child(ren) about this decision and that they cannot participate in any of the pictures.
Yes, I consent that Community of Saints School use photographs of my child/ren for marketing and advertising purposes.No, my child/ren is not able to participate in photographs to use for marketing and advertising purposes for the school.

By signing below you are agreeing to the permissions and agreements as indicated in the above form. Signature:*
Name of person completing this form:*

First NameLast Name

Pay online through the link below.*

Star Care Enrollment Fee

$60.00 Quantity

Enter coupon

Total

$0.00

Name

First NameLast Name

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

K-5 Enrollment Form - 2023 Summer Program

Parent/Guardian 1

Parent/Guardian 2

Schedule

Emergency Contacts & Healthcare Information

Student Information - 1