Parent Contact #1 Parent #1 Daytime Phone Parent #1 Email Parent Contact #2 (optional) Parent #2 Daytime Phone Parent #2 Email Home Address Emergency Contact Name Emergency Contact Phone Doctor Name Doctor Phone Student #1 Name Student #1 Grade Fall 2020 Student #1 Grade Fall 2020PKK12345678 Student #2 Name Student #2 Grade Fall 2020 Student #2 Grade Fall 2020PKK12345678 Student #3 Name Student #3 Grade Fall 2020 Student #3 Grade Fall 2020PKK12345678 Please check all weeks you plan to attend (Totus Tuus included at no charge) Please check all weeks you plan to attend (Totus Tuus included at no charge) June 1-5 June 8-12 June 15-19 June 22-26 Totus Tuus June 29- July 3 July 6-10 July 13-17 July 20-24 July 27-31 How do you plan to pay for childcare? How do you plan to pay for childcare?Weekly by CheckOnline via FACTS ($35 setup fee for non-St. Patrick students Regular care ends at 4 pm. Will you require extended care from the hours of 4:00-5:30 pm? Regular care ends at 4 pm. Will you require extended care from the hours of 4:00-5:30 pm? Yes No Submit