Ark April 2021 Registration (PreK-1st)
Please fill out this form and click submit.
Parent Contact Information
Parent Contact Name
*
Parent Contact Email
*
This address will receive a confirmation email
Parent Contact Phone
*
Ark Participation Consent
Participation Consent
*
Please select all that apply.
I give consent to the participation of the children listed in the form below to attend the St Paul's Ark Program.
Medical Emergency
*
Please select all that apply.
I understand that I will be notified in the case of a medical emergency. However, in the event that I cannot be reached, I authorize emergency contact or the church to act in my place to consent to all necessary and appropriate treatment and hospital care
Babysitting
*
Please select all that apply.
I understand that children not participating in the program are welcome to come, but that they must be dropped off at the babysitting room. I also acknowledge that children are not allowed in the parent activities and must either be in ark or babysitting
Student Information
Student Name
*
Student Class
*
Please select one option.
Archangel Raphael (3 y.o.)
St. Sophia (4 or 5 y.o.)
St. Timothy (KG - 1st)
Select Option
Archangel Raphael (3 y.o.)
St. Sophia (4 or 5 y.o.)
St. Timothy (KG - 1st)
Allergies / Medications
Activity Recommendations
Payment
Cost is $25 per student.
Payment
$25
Credit/Debit Card Number
Expiration Date/CVC
Name on Card
Card Billing Address
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Submit
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