Summer Programming Registration
Pre-Kindergarten & Kindergarten Readiness
ALL WEEKS ARE FULL - REGISTRATION FOR PK/KR IS CLOSED
email jodi.paulson@stellamaris.academy to be added to the waitlist
Student Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
*
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade entering Fall 2026
*
Pre-K
K-Readiness
School Campus attending in the Fall of 2026
Holy Rosary
St. James
Other
Guardian 1
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email (this will be the primary email address for communications)
*
example@example.com
Guardian 2
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Emergency Contact Name 1
*
First Name
Last Name
Relationship
*
Phone Number
*
-
Area Code
Phone Number
Emergency Contact Name 2
*
First Name
Last Name
Relationship
*
Phone Number
*
-
Area Code
Phone Number
Please list all additional persons authorized to pick up your child if different than the emergency contacts listed above.
Primary Care Physician
Preferred Hospital
Essentia Health-St. Mary's
St. Luke's Hospital
Health Insurance Company
*
Insurance Policy #/ Group #
*
Please furnish medical information about your child/ward which may be pertinent to his or her participation in this activity.
Do you have any questions or concerns that you would like addressed immediately?
Signature
*
My Products
prev
next
( X )
Total
$0.00
$
0.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Buy with
Buy with
Save
Submit
Should be Empty: