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 2015_____ T-shirt Size: ( ) Sm ( ) Med ( ) Lg ( ) XL ( ) XXL
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 16: Service/Jammerz Rollerdrome (9:00 AM-4:00 PM)
( ) Tuesday, June 23: Service/ Eastern Bowling Lanes (9:00 AM – 4:00 PM)
( ) Tuesday, June 30: Service/ Atlantis Water Park (9:00 AM-4:00 PM) ($20 solo event)

I have enclosed $40 for all 3 sessions. Check #________


I have enclosed $_______ for _______ sessions at $15 each. Check #_________

(If your child is only attending the final session on June 30, please pay $20)


**Please make checks payable to St. Mary 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 me and St. Mary’s of the Knobs. 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 24 ( ) June 23 ( ) June 30
Please return registration and payment by Monday, May 26th to:

Vicki Waterbury

7500 Navilleton Rd.

Floyds Knobs, IN 47119


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