Summer Daze Registration (Parental Authorization/Medical Release Form Required!)



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Summer Daze Registration

(Parental Authorization/Medical Release Form Required!)

Name________________________________Age_______Parish___________________
Address___________________________________City__________________________
State, Zip_________________Phone___________________E-mail_________________
Grade entering 2017_____ T-shirt ADULT Size: ( ) Sm ( ) Med ( ) Lg ( ) XL
List one/two persons to be in your small group if possible ________________________________________________________________________
I WILL attend Summer Daze on: (Place a check by all that apply)
( ) Tuesday, June 20: Mass/Paint OLPH / Service at SMK School (8:45 am - 4:00 pm)
( ) Tuesday, June 27: Franciscan Kitchen / Atlantis Water Park (9:00 am – 3:30 pm)
( ) Tuesday, July 11: Mt. St. Francis Service/Cookout and Fun (9:00 am -3:00 pm)

I have enclosed $35 for all 3 sessions. Check #________


I have enclosed $30 for 2 sessions. Check #________
Regrettably, my son/daughter can only attend one session for $20. Check #_______
**Please make checks payable to St. Mary’s Navilleton

For Parents: We need parents who can volunteer 1-3 days. All parents are asked to commit for the entire day. Transportation will be coordinated by Vicki. Parents are asked to accompany youth at all times as chaperones. High school youth will serve as facilitators and leaders. Please check below all the days you can help. Parental chaperones attend all activities FREE of charge!
( ) June 20 ( ) June 27 ( ) July 11
Please return registration and payment by Monday, May 28th to:
Vicki Waterbury

St. Mary’s Navilleton

7500 Navilleton Rd.

Floyds Knobs, IN 47119



For questions, to volunteer, or for more information call Vicki Waterbury at 502-741-1816.


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