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

Last Name*

Answer Required

Gender*

Answer Required

Male

Female

Birth Date*

Answer Required

Grade Entering*

Answer Required

Child 2 Information

First Name

Answer Required

Last Name

Answer Required

Gender

Answer Required

Male

Female

Birth Date

Answer Required

Grade Entering

Answer Required

Child 3 Information

First Name

Answer Required

Last Name

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Gender

Answer Required

Male

Female

Birth Date

Answer Required

Grade Entering

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Address

Street Address

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City

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Zip/Postal

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Home Phone Number

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Mother Contact Information

First Name

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Last Name

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Cell Phone Number

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Work Phone Number

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Father Contact Information

First Name

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Last Name

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Cell Phone Number

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Work Phone Number

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Emergency Contact 1 Information (other than mother / father)

First Name

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Last Name

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Relationship

Answer Required

Phone Number

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Emergency Contact 2 Information (other than mother / father)

First Name

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Last Name

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Relationship

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Phone Number

Number Required

Camper Allergies / Important Information / Medication

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Form Completed By:

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Registration Fee

$20 Activity Fee Per Child

Total Registration Fee*

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Summer Breeze Rates

$ 170 Per Child - One Week

$330 Per Child - Two Weeks

$297 Per Child - Summer Camp Discount

Number of Weeks*

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Please Select Weeks*

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Both Weeks

June 5-9

June 12-16

Special Notes About Camper Attendance

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Total Summer Breeze Tuition Fees*

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

Answer Required

Yes

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

Answer Required

Yes

Please fix the highlighted areas below before submitting.

Summer Breeze 2023 - WAITLIST