Summer Breeze 2023 - WAITLIST | St. Matthew the Apostle Catholic School

Summer Breeze is now full. Please fill out the form below to be placed on the wait list. You will be contacted if a spot opens up.

Child 1 Information

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Gender*

Answer required for "Gender"

Male

Female

Birth Date*

Answer required for "Birth Date"

Grade Entering*

Answer required for "Grade Entering"

Child 2 Information

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Gender

Answer required for "Gender"

Male

Female

Birth Date

Answer required for "Birth Date"

Grade Entering

Answer required for "Grade Entering"

Child 3 Information

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Gender

Answer required for "Gender"

Male

Female

Birth Date

Answer required for "Birth Date"

Grade Entering

Answer required for "Grade Entering"

Address

Street Address

Answer required for "Street Address"

City

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Home Phone Number

Number Required

Mother Contact Information

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Answer required for "Email"

Cell Phone Number

Number Required

Work Phone Number

Number Required

Father Contact Information

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Answer required for "Email"

Cell Phone Number

Number Required

Work Phone Number

Number Required

Emergency Contact 1 Information (other than mother / father)

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Relationship

Answer required for "Relationship"

Answer required for "Email"

Phone Number

Number Required

Emergency Contact 2 Information (other than mother / father)

First Name

Answer required for "First Name"

Last Name

Answer required for "Last Name"

Relationship

Answer required for "Relationship"

Answer required for "Email"

Phone Number

Number Required

Camper Allergies / Important Information / Medication

Answer required for "Camper Allergies / Important Information / Medication"

Form Completed By:

Answer required for "Form Completed By:"

Registration Fee

$20 Activity Fee Per Child

Total Registration Fee*

Answer required for "Total Registration Fee"

Summer Breeze Rates

$ 170 Per Child - One Week

$330 Per Child - Two Weeks

$297 Per Child - Summer Camp Discount

Number of Weeks*

Answer required for "Number of Weeks"

Please Select Weeks*

Answer required for "Please Select Weeks"

Both Weeks

June 5-9

June 12-16

Special Notes About Camper Attendance

Answer required for "Special Notes About Camper Attendance"

Total Summer Breeze Tuition Fees*

Answer required for "Total Summer Breeze Tuition Fees"

My child/children will attend Before Camp Care ($5 per day via Summer Camp)*

Answer required for "My child/children will attend Before Camp Care ($5 per day via Summer Camp)"

Yes

My child/children will attend After Camp Care ($10 per day via Summer Camp)*

Answer required for "My child/children will attend After Camp Care ($10 per day via Summer Camp)"

Yes

Please fix the highlighted areas below before submitting.

Summer Breeze 2023 - WAITLIST