Form Test Page Step 1 of 6 16% How many Children would you like to Register?123Are you a 2020-2021 or 2021-2022 St. Anthony School Family?YesNoIf not, what school does your child(ren) currently attend?Child #1Child #1 First and Last Name First Last Child #1 Date of Birth Date Format: MM slash DD slash YYYY Child #1 Rising Grade123KPK3PK4Other / Add NewChild #1 GradeChild #1 Teacher NameSelect a Summer Camp Theme Child #1 - Current Families All Wks: Current Families Wk 1: Jun 21-25 - Current Families Wk 2: Jun 28- Jul 2: Current Families Wk 3: Jul 5-9: Current Families Wk 4: Jul 12-16: Current Families Wk 5: Jul 19-23: Current Families Wk 6: Jul 26-30: Current Families Wk 7: Aug 2-6: Current Families Wk 8: Aug 9-13: Current Families Select a Summer Camp Theme Child #1 - Non St Anthony Families All Wks: Non School Families Wk 1: June 21-25 - Non St Anthony Families Wk 2: Jun 28- Jul 2: Non St Anthony Families Wk 3: Jul 5-9: Non St Anthony Families Wk 4: Jul 12-16: Non St Anthony Families Wk 5: Jul 19-23: Non St Anthony Families Wk 6: Jul 26-30: Non St Anthony Families Wk 7: Aug 2-6: Non St Anthony Families Wk 8: Aug 9-13: Non St Anthony Families Child 1: How many slices of pizza would you like each week?1 Slice2 SlicesNo SlicesEach slice is $2.50 per weekMilk will be provided (FREE) - Select one Child #1White MilkChocolate MilkMy child does not drink milk Pizza will be served on Fridays. Child #2Child #1 First and Last Name First Last Child #2 Date of Birth Date Format: MM slash DD slash YYYY Child #2 Rising Grade123KPK3PK4Other / Add NewChild #2 GradeChild #2 Teacher NameSelect a Summer Camp Theme Child #2 - Current Families All Wks: Current Families Wk 1: Jun 21-25 - Current Families Wk 2: Jun 28- Jul 2: Current Families Wk 3: Jul 5-9: Current Families Wk 4: Jul 12-16: Current Families Wk 5: Jul 19-23: Current Families Wk 6: Jul 26-30: Current Families Wk 7: Aug 2-6: Current Families Wk 8: Aug 9-13: Current Families Select a Summer Camp Theme Child #2 - Non St Anthony Families All Wks: Non School Families Wk 1: June 21-25 - Non St Anthony Families Wk 2: Jun 28- Jul 2: Non St Anthony Families Wk 3: Jul 5-9: Non St Anthony Families Wk 4: Jul 12-16: Non St Anthony Families Wk 5: Jul 19-23: Non St Anthony Families Wk 6: Jul 26-30: Non St Anthony Families Wk 7: Aug 2-6: Non St Anthony Families Wk 8: Aug 9-13: Non St Anthony Families Child 2: How many slices of pizza would you like each week?1 Slice2 SlicesNo SlicesEach slice is $2.50 per weekMilk will be provided (FREE) - Select one Child #2White MilkChocolate MilkMy child does not drink milk Pizza will be served on Fridays. Child #3Child #3 First and Last Name First Last Child #3 Date of Birth Date Format: MM slash DD slash YYYY Child #3 Rising Grade123KPK3PK4Other / Add NewChild #3 GradeChild #3 Teacher NameSelect a Summer Camp Theme Child #3 - Current Families All Wks: Current Families Wk 1: Jun 21-25 - Current Families Wk 2: Jun 28- Jul 2: Current Families Wk 3: Jul 5-9: Current Families Wk 4: Jul 12-16: Current Families Wk 5: Jul 19-23: Current Families Wk 6: Jul 26-30: Current Families Wk 7: Aug 2-6: Current Families Wk 8: Aug 9-13: Current Families Select a Summer Camp Theme Child #3 - Non St Anthony Families All Wks: Non School Families Wk 1: June 21-25 - Non St Anthony Families Wk 2: Jun 28- Jul 2: Non St Anthony Families Wk 3: Jul 5-9: Non St Anthony Families Wk 4: Jul 12-16: Non St Anthony Families Wk 5: Jul 19-23: Non St Anthony Families Wk 6: Jul 26-30: Non St Anthony Families Wk 7: Aug 2-6: Non St Anthony Families Wk 8: Aug 9-13: Non St Anthony Families Child 3: How many slices of pizza would you like each week?1 Slice2 SlicesNo SlicesEach slice is $2.50 per weekMilk will be provided (FREE) - Select one Child #3White MilkChocolate MilkMy child does not drink milk Pizza will be served on Fridays. Current Fam Child #1 All Wks: 1 Pizza Slice Price: $20.00 Current Fam Child #1 All Wks: 2 Pizza Slices Price: $40.00 Non-Fam Child #1 All Wks: 1 Pizza Slice Price: $20.00 Non-Fam Child #1 All Wks: 2 Pizza Slices Price: $40.00 Current Fam Child #2 All Wks: 1 Pizza Slice Price: $20.00 Current Fam Child #2 All Wks: 2 Pizza Slices Price: $40.00 Non-Fam Child #2 All Wks: 1 Pizza Slice Price: $20.00 Non-Fam Child #2 All Wks: 2 Pizza Slices Price: $40.00 Current Fam Child #3 All Wks: 1 Pizza Slice Price: $20.00 Current Fam Child #3 All Wks: 2 Pizza Slices Price: $40.00 Non-Fam Child #3 All Wks: 1 Pizza Slice Price: $20.00 Non-Fam Child #3 All Wks: 2 Pizza Slices Price: $40.00 Child #1 All Wks: Current Families Price: $2,400.00 Child #2 All Wks: Current Families Price: $2,400.00 Child #3 All Wks: Current Families Price: $2,400.00 Child #1 Wk 1: Jun 21-25 - Current Families Price: $300.00 Child #1 Wk 1: Jun 21-25 - Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 1: Jun 21-25 - Non-Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 1: Jun 21-25 - Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 1: Jun 21-25 - Non-Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 1: Jun 21-25 - Current Families Price: $300.00 Child #2 Wk 1: Jun 21-25 - Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 1: Jun 21-25 - Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 1: Jun 21-25 - Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 1: Jun 21-25 - Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 1: Jun 21-25 - Current Families Price: $300.00 Child #3 Wk 1: Jun 21-25 - Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 1: Jun 21-25 - Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 1: Jun 21-25 - Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 1: Jun 21-25 - Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 2: Jun 28- Jul 2: Current Families Price: $300.00 Child #1 Wk 2: Jun 28- Jul 2: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 2: Jun 28- Jul 2: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 2: Jun 28- Jul 2: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 2: Jun 28- Jul 2: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 2: Jun 28- Jul 2: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 2: Jun 28- Jul 2: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 2: Jun 28- Jul 2: Current Families - 2 Pizza Slice Price: $5.00 Child #2 Wk 2: Jun 28- Jul 2: Non Families - 2 Pizza Slice Price: $5.00 Child #3 Wk 2: Jun 28- Jul 2: Current Families Price: $300.00 Child #3 Wk 2: Jun 28- Jul 2: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 2: Jun 28- Jul 2: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 2: Jun 28- Jul 2: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 2: Jun 28- Jul 2: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 3: Jul 5-9: Current Families Price: $300.00 Child #1 Wk 3: Jul 5-9: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 3: Jul 5-9: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 3: Jul 5-9: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 3: Jul 5-9: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 3: Jul 5-9: Current Families Price: $300.00 Child #2 Wk 3: Jul 5-9: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 3: Jul 5-9: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 3: Jul 5-9: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 3: Jul 5-9: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 3: Jul 5-9: Current Families Price: $300.00 Child #3 Wk 3: Jul 5-9: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 3: Jul 5-9: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 3: Jul 5-9: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 3: Jul 5-9: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 4: Jul 12-16: Current Families Price: $300.00 Child #1 Wk 4: Jul 12-16: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 4: Jul 12-16: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 4: Jul 12-16: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 4: Jul 12-16: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 4: Jul 12-16: Current Families Price: $300.00 Child #2 Wk 4: Jul 12-16: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 4: Jul 12-16: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 4: Jul 12-16: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 4: Jul 12-16: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 4: Jul 12-16: Current Families Price: $300.00 Child #3 Wk 4: Jul 12-16: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 4: Jul 12-16: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 4: Jul 12-16: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 4: Jul 12-16: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 5: Jul 19-23: Current Families Price: $300.00 Child #1 Wk 5: Jul 19-23: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 5: Jul 19-23: Non Families - 1 Pizza Slice Price: $5.00 Child #1 Wk 5: Jul 19-23: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 5: Jul 19-23: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 5: Jul 19-23: Current Families Price: $300.00 Child #2 Wk 5: Jul 19-23: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 5: Jul 19-23: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 5: Jul 19-23: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 5: Jul 19-23: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 5: Jul 19-23: Current Families Price: $300.00 Child #3 Wk 5: Jul 19-23: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 5: Jul 19-23: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 5: Jul 19-23: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 5: Jul 19-23: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 6: Jul 26-30: Current Families Price: $300.00 Child #1 Wk 6: Jul 26-30: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 6: Jul 26-30: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 6: Jul 26-30: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 6: Jul 26-30: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 6: Jul 26-30: Current Families Price: $300.00 Child #2 Wk 6: Jul 26-30: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 6: Jul 26-30: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 6: Jul 26-30: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 6: Jul 26-30: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 6: Jul 26-30: Current Families Price: $300.00 Child #3 Wk 6: Jul 26-30: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 6: Jul 26-30: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 6: Jul 26-30: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 6: Jul 26-30: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 7: Aug 2-6: Current Families Price: $300.00 Child #1 Wk 7: Aug 2-6: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 7: Aug 2-6: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 7: Aug 2-6: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 7: Aug 2-6: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 7: Aug 2-6: Current Families Price: $300.00 Child #2 Wk 7: Aug 2-6: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 7: Aug 2-6: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 7: Aug 2-6: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 7: Aug 2-6: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 7: Aug 2-6: Current Families Price: $300.00 Child #3 Wk 7: Aug 2-6: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 7: Aug 2-6: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 7: Aug 2-6: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 7: Aug 2-6: Non Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 8: Aug 9-13: Current Families Price: $300.00 Child #1 Wk 8: Aug 9-13: Current Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 8: Aug 9-13: Non Families - 1 Pizza Slice Price: $2.50 Child #1 Wk 8: Aug 9-13: Current Families - 2 Pizza Slices Price: $5.00 Child #1 Wk 8: Aug 9-13: Non Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 8: Aug 9-13: Current Families Price: $300.00 Child #2 Wk 8: Aug 9-13: Current Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 8: Aug 9-13: Non Families - 1 Pizza Slice Price: $2.50 Child #2 Wk 8: Aug 9-13: Current Families - 2 Pizza Slices Price: $5.00 Child #2 Wk 8: Aug 9-13: Non Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 8: Aug 9-13: Current Families Price: $300.00 Child #3 Wk 8: Aug 9-13: Current Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 8: Aug 9-13: Non Families - 1 Pizza Slice Price: $2.50 Child #3 Wk 8: Aug 9-13: Current Families - 2 Pizza Slices Price: $5.00 Child #3 Wk 8: Aug 9-13: Non Families - 2 Pizza Slices Price: $5.00 Child #1 All Wks: Non School Families Price: $3,200.00 Child #2 All Wks: Non School Families Price: $3,200.00 Child #3 All Wks: Non School Families Price: $3,200.00 Child #1 Wk 1: June 21-25 - Non St Anthony Families Price: $400.00 Child #2 Wk 1: June 21-25 - Non St Anthony Families Price: $400.00 Child #3 Wk 1: June 21-25 - Non St Anthony Families Price: $400.00 Child #1 Wk 2: Jun 28- Jul 2: Non St Anthony Families Price: $400.00 Child #2 Wk 2: Jun 28- Jul 2: Non St Anthony Families Price: $400.00 Child #3 Wk 2: Jun 28- Jul 2: Non St Anthony Families Price: $400.00 Child #1 Wk 3: Jul 5-9: Non St Anthony Families Price: $400.00 Child #2 Wk 3: Jul 5-9: Non St Anthony Families Price: $400.00 Child #3 Wk 3: Jul 5-9: Non St Anthony Families Price: $400.00 Child #1 Wk 4: Jul 12-16: Non St Anthony Families Price: $400.00 Child #2 Wk 4: Jul 12-16: Non St Anthony Families Price: $400.00 Child #3 Wk 4: Jul 12-16: Non St Anthony Families Price: $400.00 Child #1 Wk 5: Jul 19-23: Non St Anthony Families Price: $400.00 Child #2 Wk 5: Jul 19-23: Non St Anthony Families Price: $400.00 Child #3 Wk 5: Jul 19-23: Non St Anthony Families Price: $400.00 Child #1 Wk 6: Jul 26-30: Non St Anthony Families Price: $400.00 Child #2 Wk 6: Jul 26-30: Non St Anthony Families Price: $400.00 Child #3 Wk 6: Jul 26-30: Non St Anthony Families Price: $400.00 Child #1 Wk 7: Aug 2-6: Non St Anthony Families Price: $400.00 Child #2 Wk 7: Aug 2-6: Non St Anthony Families Price: $400.00 Child #3 Wk 7: Aug 2-6: Non St Anthony Families Price: $400.00 Child #1 Wk 8: Aug 9-13: Non St Anthony Families Price: $400.00 Child #2 Wk 8: Aug 9-13: Non St Anthony Families Price: $400.00 Child #3 Wk 8: Aug 9-13: Non St Anthony Families Price: $400.00 Camp Total Cost $0.00 Parent InformationParent First and Last Name First Last PhoneEmail Note:Summer Camp Emergency FormBest Email for Communication Child's Date of Birth Date Format: MM slash DD slash YYYY GenderMaleFemaleHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Father's Name First Last Father Place Employed:Father Work Phone:Father Cell Phone:Mother's Name First Last Mother's Place Employed:Mother's Work Phone:Mother's Cell Phone:Home Address (If different from child) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Child's Special Needs (if any)Medical condition we should know about?List daily medication require (if any)Allergies we should know about?Type of Allergy or food intolerance?Allergy reaction: Action to be taken: Emergency Contact (Must not be parents. All four phone numbers must be different)Emergency Contact Name (Contact #1) First Last Relationship (Emergency contact #1)Address (Emergency contact #1) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone Number (Emergency contact #1)Cell Phone Number (Emergency contact #1)Emergency Contact Name (Contact #2) First Last Relationship (Emergency contact #2)Address (Emergency contact #2) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Home Phone Number (Emergency contact #2)Cell Phone Number (Emergency contact #2)Individuals Authorized to Pick UpName Authorized to Pick Up & Relationship:Name Authorized to Pick Up & Relationship #2: Waiver Information / Right to ObjectMy child is allowed to participate in all materials/productions.YesNoPlease check all of the following materials/production areas that we do NOT have permission to use for your child. Please note names are never associated with pictures. Audio Recording Video Recording School Promotional Literature School website/Facebook/Instagram Other Please Specify:Note: I agree to notify the camp within 24 hours if my child or any member of my immediate household has developed a communicable disease. I agree to notify the camp immediately if the disease is life threatening. I agree to pick up my sick or injured child within 1 hour of being contacted. If I cannot be reached, my emergency contacts can be called to pick up my child. Additionally, if I cannot be contacted in an emergency, the camp has my permission to take my child to the emergency room of the nearest hospital and I hereby authorize its medical staff to provide treatment, which a physician deems necessary for the well-being of my child. Method of Payment- FACTS: Please only select FACTS as a method of payment if you have an active agreement with FACTS and a current bank account active otherwise you will be charge a $20.00 fee in order to re-activate your account. By submitting this payment form and selecting FACTS you authorize St. Anthony of Padua School to divide the total cost in your remaining FACTS payments. - Credit Card: Please issue your payment right away at the School website or visit the School Office to pay in person. - Check: Please send your check right away with your child or stop by the School Office to pay in person. I agree to abide by the regulations of St. Anthony of Padua School and to pay tuition and other applicable fees in a timely manner.Select Method of PaymentCredit CardFACTSCheck/CashDate Date Format: MM slash DD slash YYYY Time : HH MM AM PM SignatureTotal $0.00 Product Name Price: $0.00 Quantity: