2022 IC Summer Program Enrollment Form

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*Dates: June 20th - 24th
*Please complete this form and turn in your $125 Enrollment Fee to finalize the enrollment process. (One form per child)
*There is a multi-child discount: 2nd child $100, 3rd child and on $88 each

For questions please email icsummerprogram@icsnlr.org.

Please allow 24 hours for a response.

Online EnrollmentForm Deadline:

This form must be completed and sent by May 20th.
ANY FORMS SENT IN AFTER THIS DATE ARE NOT GUARANTEED A T-SHIRT.

Student Information

First Name: *

Last Name: *

Preferred Name: *

Tshirt Size *

*STUDENTS ENROLLING AFTER MAY 17TH ARE NOT GUARANTEED A T-SHIRT

Child Small

Child Medium

Child Large

Adult Small

Adult Medium

Adult Large

Other:

Age: *

Birthday: *

mm/dd/yyyy

Child's Current School: *

Other:

Enrolling in Grade: *

(Please check the box for the grade your child WILL BE ENTERING NEXT SCHOOL YEAR.)

Home Phone Number: *

Street Address: *

City: *

State: *

Zip: *

Pick Up Information: *

List all names & phone numbers of people who may pick your child up, or check them out during the day.

Mother's Information

First & Last Name: *

Cell Phone: *

With Area Code

Home Phone:

With Area Code

Work Phone:

With Area Code

Mother's Email Address: *

Father's Information

First & Last Name: *

Cell Phone: *

With Area Code

Work Phone:

With Area Code

Home Phone:

With Area Code

Father's Email Address: *

Emergency Contact

First & Last Name: *

Relationship to Student: *

Cell Phone: *

With Area Code

Work Phone:

With Area Code

Home Phone:

With Area Code

Other Information

Parents/Guardians are: *

Married

Divorced

Separated

Widowed

Single

Student lives with: *

Both Parents

Mother

Father

Guardian

Stepmother

Stepfather

Please list any allergies or special needs your child may have: *

Type "None" if they do not have any allergies.

Please list any medications your child may take: *

Type "None" if they do not take any medication

Social Media Agreements *

Here at IC we firmly believe that the parents are first and foremost the primary educators of their children. In support of this belief it is absolutely essential that parents, school staff, and administration support each other. In order to communicate the importance of this point, IC has developed the following policy for all students, parents, school staff, and administration. 1) When posting to social networks, please be ever vigilant in maintaining professionalism. 2) Vulgar or unchristian-like postings or photos WILL NOT BE TOLERATED AT ANY TIME. 3) Remember, we are all representatives of IC School whether we are at school, a school-sanctioned event, at home, out in the community or at any other time. 4) Be mindful of sending inappropriate messages or information critical of other parents, students, school faculty, and/or the school itself. 5) Social networking sites are not the appropriate arenas for airing complaints. By checking "Agree" below you further verify that you have read and agree to follow the following policy: IC Social Networking Policy.

Agree

Disagree

Photo Release Policy: *

I give permission to Immaculate Conception Catholic Summer Program to photograph my child/children. Furthermore, I agree to let Immaculate Conception Summer Program use photos that include my child/children in their school publications (social media posts, newsletters, brochures, etc.) and/or school website. I understand that my child/children will not be identified by his/her full name if a photo of him/her should be used unless parent is notified and consensual. By checking "Agree" below you further verify that you have read and agree to follow the following policy: IC Photo Release Policy.

Agree

Disagree

FACTS: I give permission to Immaculate Conception Catholic School to draft my child's Summer Program Enrollment Fee from my FACTS account: *

Agree

I would like to use a different payment method

Summer Program Course Descriptions:

Students will rotate through each class in their grade level daily. Remember, it is the grade they will be entering next year.

Entering 1st & 2nd Grade:

Mrs. Moore: Who’s ready for a week full of adventure? Come take a hike this summer with Freddie Falcon and hear a few TALL TALES around the campground. There will be plenty of projects going on too! Hope to see you soon!

Miss Wallin: Come TAKE A HIKE with Miss Wallin to explore the wonders of science in nature. Be prepared to be the catch of the day and have S’More fun than you can imagine! Happy trails to happy campers!

Miss O’Connor: Let’s get excited to take a HIKE with Freddy Falcon. I cannot wait to play S’MORE games and learn how to be SWEET and STICK together! Everyone is sure to leave a happy camper.

Entering 3rd & 4th Grade:

Mrs. Bibb: Come explore the great outdoors! There will be hands-on crafts and activities! We will have s’more fun than you can imagine!

Mrs. Moody: Have you ever heard of a "solar oven"? Well, we're going to do some baking outdoors, with help from Mr. Sun. Let's get ready for “S’MORE FUN” than you can imagine. Come join me, and let’s have some fun together. Can’t wait to see your smiling faces!

Miss Mary Kate: Freddie Falcon is ready for PE! Are you?! You don't want to miss out this summer! We will play so many games and sports such as “red light green light” and soccer and even get to use some hula hoops! I am so excited to see everyone there for the best week of the summer!!

Entering 5th - 8th Grade:

Mrs. Chanda: Come look to nature for inspiration during the week in art class. We will take our inspiration from plants and animals to create some amazing art together. It will be a great time full of creativity and exploration!

Chef Erica: Calling all Jr. Chefs... "HIKE ON INTO THE KITCHEN" with me for some great fun!!! You will be able to make some variety of campfire food and join in on the "taste-testing"!! You will also learn about safe cooking and proper clean-up as well!!! Let's have some S’MORE fun!!!

Coach Cam: Ready for a jam-packed week of fun P.E games? We will play a variety of games and work on skills & drills from several sports. You don’t want to miss out on all the fun, building new skills, and having a blast with friends. Can’t wait to see you all there!

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