Summer Enrichment Program Registration Form

Summer Enrichment Program Registration

Use this form to register for our 2024 Summer Enrichment Program at Worship United Church. Please complete the entire form and select your preferred payment option.
Student's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student's Grade (in Aug. 2024)*
Select the grade the student will be in for the upcoming 2024 - 2025 school year.
Date of Birth*

MonthDayYear
Date
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Relationship to student*
Emergency Contact Information
Please enter the name(s) of the individuals we should contact in the event of an emergency:
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to student*
Please enter how this person is related to the student.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship to student*
Student Health Information
Medical Conditions*
Please list any medical conditions and if the students has none, please put N/A
Student Allergies
Please list food, medication, and environmental allergies
Medications
Please list any medications that your child is taking that will need to be administered during the summer program hours
Permission for Emergency Medical Treatment. In the event of a medical emergency, do you grant Worship United Church permission to allow certified Emergency Medical Technicians (EMTs) and/or licensed paramedics to administer emergency care to your child?
Please select "Yes" or "No"

YesNo

Grades 3 - 6, $150 per Week, $630 all 6 weeks

It’s a great time to plan for your child’s time off from school. The Worship United Church Summer Enrichment Program is the perfect choice to keep your child engaged in positive activities that will foster his or her personal and academic growth. Our sessions are on Monday - Thursday from 9:00am to 2:00pm. Aftercare is available from 2:00pm to 6:00pm for a small additional fee. Your child will get to spend his or her days surrounded by friends, enjoying their summer, all under the watchful care of our talented and responsible staff. Our program will consist of a combination of STEM learning, arts and crafts, team building, a final project, group games, and more.
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Summer Enrichment Program Total Fee
$630.00 Quantity

Summer Enrichment Program Weekly Fee (you will be billed weekly for the remaining weeks)
$150.00 Quantity

Total

$0.00

Payment Methods

Debit or Credit Card

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

Should be Empty:

Summer Enrichment Program Registration

Emergency Contact Information

Student Health Information

Grades 3 - 6, $150 per Week, $630 all 6 weeks