CfUT Summer School Application

2024 Summer School Application

LUMIN: St. Martini
Summer School Dates & Times

Dates: Thursday, June 27, 2024 – Thursday, July 25, 2024 **No school July 4th or 5th** Times: 7:30 am – 2:00 pm Mon, Tues, Thurs, and Fri 7:30 am – 1:00 pm Wednesdays (Breakfast and Lunch included all days)
Parent/Guardian Full Name

First NameLast Name
E-mail
example@example.com
Phone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student 1 Information
Name*

Student's First NameStudent's Last Name
This student is enrolled at LUMIN: St. Martini for the 2024-2025 academic year, entering Grades K-8 and is committed to attend 15 or more days of Summer School*

YesNo
Student Date of Birth*

MonthDayYear
Date
Student's Incoming Grade (For Fall 2024)*
Student's Allergies*
Student's Current Medication*
Uniform

There is no cost to attend summer school; however, students are required to wear a uniform. A uniform consists of the summer school t-shirt and regular uniform bottoms (pants, skirts, etc.), shoes, and socks. The summer school uniform t-shirt must be purchased for $5.
This is a non-refundable cost that must be submitted with this application.
T-Shirt Size*
Number of Shirts*
Add another Student

YesNo

Student 2 Information
Name*

Student's First NameStudent's Last Name
This student is enrolled at LUMIN: St. Martini for the 2024-2025 academic year, entering Grades K-8 and is committed to attend 15 or more days of Summer School*

YesNo
Student Date of Birth*

MonthDayYear
Date
Student's Incoming Grade (For Fall 2024)*
Student's Allergies*
Student's Current Medication*
Uniform

There is no cost to attend summer school; however, students are required to wear a uniform. A uniform consists of the summer school t-shirt and regular uniform bottoms (pants, skirts, etc.), shoes, and socks. The summer school uniform t-shirt must be purchased for $5.
This is a non-refundable cost that must be submitted with this application.
T-Shirt Size*
Number of Shirts*
Add another Student

YesNo

Student 3 Information
Name*

Student's First NameStudent's Last Name
This student is enrolled at LUMIN: St. Martini for the 2024-2025 academic year, entering Grades K-8 and is committed to attend 15 or more days of Summer School*

YesNo
Student Date of Birth*

MonthDayYear
Date
Student's Incoming Grade (For Fall 2024)*
Student's Allergies*
Student's Current Medication*
Uniform

There is no cost to attend summer school; however, students are required to wear a uniform. A uniform consists of the summer school t-shirt and regular uniform bottoms (pants, skirts, etc.), shoes, and socks. The summer school uniform t-shirt must be purchased for $5.
This is a non-refundable cost that must be submitted with this application.
T-Shirt Size*
Number of Shirts*
Add another Student

YesNo

Student 4 Information
Name*

Student's First NameStudent's Last Name
This student is enrolled at LUMIN: St. Martini for the 2024-2025 academic year, entering Grades K-8 and is committed to attend 15 or more days of Summer School*

YesNo
Student Date of Birth*

MonthDayYear
Date
Student's Incoming Grade (For Fall 2024)*
Student's Allergies*
Student's Current Medication*
Uniform

There is no cost to attend summer school; however, students are required to wear a uniform. A uniform consists of the summer school t-shirt and regular uniform bottoms (pants, skirts, etc.), shoes, and socks. The summer school uniform t-shirt must be purchased for $5.
This is a non-refundable cost that must be submitted with this application.
T-Shirt Size*
Number of Shirts*
Add another Student

YesNo

Student 5 Information
Name*

Student's First NameStudent's Last Name
This student is enrolled at LUMIN: St. Martini for the 2024-2025 academic year, entering Grades K-8 and is committed to attend 15 or more days of Summer School*

YesNo
Student Date of Birth*

MonthDayYear
Date
Student's Incoming Grade (For Fall 2024)*
Student's Allergies*
Student's Current Medication*
Uniform

There is no cost to attend summer school; however, students are required to wear a uniform. A uniform consists of the summer school t-shirt and regular uniform bottoms (pants, skirts, etc.), shoes, and socks. The summer school uniform t-shirt must be purchased for $5.
This is a non-refundable cost that must be submitted with this application.
T-Shirt Size*
Number of Shirts*

Pick Up Information

Transportation will not be provided. For security purposes, each child will need to be signed out when they are picked up at the 2:00 pm dismissal on Mondays, Tuesdays, Thursdays, and Fridays, and 1:00 pm on Wednesdays. Please provide the names and phone numbers of the adults who have permission to pick up your child.
Authorized Pick-Up Adult*

First NameLast Name
Adult's Phone Number*
Please enter a valid phone number.
This adult is aware transportation will not be provided. This adult is also aware students must be picked up at the 2pm dismissal on Mondays, Tuesdays, Thursdays, and Fridays, and 1pm on Wednesdays*

Yes
Add another Pick-Up Adult*

YesNo

Authorized Pick-Up Adult*

First NameLast Name
Adult's Phone Number*
Please enter a valid phone number.
This adult is aware transportation will not be provided. This adult is also aware students must be picked up at the 2pm dismissal on Mondays, Tuesdays, Thursdays, and Fridays, and 1pm on Wednesdays*

Yes

Emergency Contact Information
Emergency Contact's Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Secondary Phone Number
Please enter a valid phone number.
Emergency Contact Relationship to Student*
Add another Emergency Contact*

YesNo

Emergency Contact's Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Emergency Contact Secondary Phone Number
Please enter a valid phone number.
Emergency Contact Relationship to Student*

Parental/Guardian Permission and Agreement

I give my child(ren), permission to participate in the 2024 Summer School. By signing below, I grant permission for my child(ren) to participate in all activities at Summer School, including any field trips during the afternoon enrichment activities. I acknowledge that participation in Summer School involves inherent risks, including risk of injury and illness. On behalf of my child(ren), I voluntarily assume such risks. I and anyone who may claim on my behalf do not hold CfUT or the teachers or staff of the Summer School program responsible for the risks we have assumed or for any harm that may occur in the course of the Summer School program. I consent to the participation in interviews, the use of quotes, and the taking of photographs, movies or video tapes of the student(s) named above. I also grant CfUT the right to edit, use, and reuse said products for non-profit purposes including use in print, on the internet, and all other forms of media. I hereby release and forever discharge CfUT and its affiliates, successors and assigns, officers, employees, representatives, partners, agents and insurers from all claims, demands, and liabilities whatsoever in connection with the Summer School program, including but not limited to claims, demands, and liabilities allegedly arising from CfUT’s own negligence. I have carefully read and fully understand all of the provisions of this Agreement and am freely, knowingly, and voluntarily entering into the same.
Signature*

Payment

This is a non-refundable cost that must be submitted with this application. Additional shirts may be purchased. You may pay using an existing PayPal account, or any major credit card / debit card.
Uniform T-Shirt Total*
Uniform T-Shirt Payment Total

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Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

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2024 Summer School Application

Summer School Dates & Times

Student 1 Information

Student 2 Information

Student 3 Information

Student 4 Information

Student 5 Information

Pick Up Information

Emergency Contact Information

Parental/Guardian Permission and Agreement

Payment