God's Kids Enrollment Form

St. Felix Summer Program Registration Form
1st Child's Last Name*
First*
MI*
Grade in upcoming School Year*

2nd Child
Last Name
First
MI
Grade in upcoming School Year_

3rd Child
Last Name
First
MI
Grade in upcoming School Year

4th Child
Last Name
First
MI
Grade in upcoming School Year_

Parent Information
Mother's Name*
Email*
example@example.com
Mother's Address*
Home Phone
Mobile Phone*
Employment
Work Phone
Father's Name*
E mail*
example@example.com
Father's Address*
Home Phone
Mobile Phone*
Employment
Work Phone
Emergency Contacts
Child's Doctor*
Phone*
Child's Dentist*
Phone*
Parents are responsible for all medical/ambulance expenses should they be required. This person is authorized to pick up my child or to be contacted in an emergency.
Authorized Pick up Person(s)
Name*
Relationship*
Phone*
Name
Relationship
Phone
If there is anyone NOT authorized to take your child from the program you must notify us and provide the necessary documents (Order for Protection or Custody Order)
Health and Socialization
Do any of your children have food or medication allergies? If so, please list and/or describe:
Do any of your children use medications? If so, please list and/or describe
Please describe the characteristics, socialization, interests, special needs, etc. of your children
St. Felix Summer Program is sponsored by St. Felix Catholic School and is designed to provide a safe and enriching environment for children age 3 through grade six. We are open during the summer months M-F with the exception of Memorial Day and the Fourth of July.

Program Closings:
May 29th through June 2nd, July 3rd, Indepence Day, August 21st through 25th and advanced notice will be given if there are any additional days that the program will close.

Billing and Payments
For billing purpose, we ask for parents to confirm which days are needed by the Wednesday prior to the week before care is needed. The confirmation sign-up is done electronically on the God's Kids web page or on the weekly calendar by the sign-up book. Bills will be done on a weekly basis. The bill will be placed in your family folder on Mondays and payment is due by Friday of the same week. A $5.00 late fee will be added the following Monday if the bill has not been paid or a payment plan is in place.

There is a late pick up fee of $5.00 per child for every fifteen minutes or more your child remains at the program after closing.

Please check programs you'll use and circle days you intend to send your children.
ALL DAY CARE (DROP IN BASIS) 8:00 a.m. - 5:30 p.m.

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
ALL DAY CARE (REGULAR BASIS) 8:00 a.m. - 5:30 p.m.

MondayTuesdayWednesdayThursdayFriday
HALF DAY CARE {REGULAR BASIS) 8:00 a.m. - 5:30 p.m.

MondayTuesdayWednesdayThursdayFriday
HALF DAY CARE {DROP IN BASIS) 8:00 a.m. - 5:30 p.m.

MondayTuesdayWednesdayThursdayFriday
ALL DAY CARE (REGULAR BASIS) 8:00 a.m. - 5:30 p.m.

MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Pricing Information:

All Day: (over four hours) $35.00 per day
Part Day: (under four hours) $18.00 per day

There is a $25.00 non-refundable registration fee (per family) at the time of registration.

I consent to the enrollment of my child(ren) in the St. Felix Summer Program.
Parent Signature

Clear
Date

MonthDayYear
Authorization Form

I give consent for my child to take part in field trips or excursions under proper supervision.

I give consent for staff to apply sunscreen which I will provide. Please label with your family name.

I give consent to have pictures of my child taken by the news media and/or staff.

I give permission to the program to take whatever emergency measures that are deemed necessary for the care and protection of my child while under the supervision of the center.
Parent Signature

Clear
Date

MonthDayYear
Should be Empty:

St. Felix Summer Program Registration Form

Parent Information

Emergency Contacts

Authorized Pick up Person(s)

Health and Socialization

Pricing Information:

I consent to the enrollment of my child(ren) in the St. Felix Summer Program.

Authorization Form