NCRJHS

Summer Stars 2010 ~ ACADEMIC COURSES

Registration Form

Your child MUST be pre-registered for all courses! Current/Incoming NC Student Summer Registrations will be taken immediately. Non-NC Student Summer Registrations will begin on April 15 (child must be entering grades 7 or 8).

Non-refundable fee required upon registration are a $55 deposit per course. The balance is due one week prior to the start of the course.  PLEASE WRITE A SEPARATE CHECK FOR EACH SUMMER COURSE YOUR CHILD IS TAKING! Please mail this form with your check(s) to Nashua Catholic, 6 Bartlett Ave. Nashua, NH 03064 ATTENTION: Deb Matson Champagne. We will advise everyone on the wait list as to the status of the program. More information will be sent to you in the up coming weeks. Please email questions to: dmatson@ncrjhs.org.

(Please PRINT)

Child’s Full Name: ____________________________________________________________

School Child Currently Attends: ________________________________________________

School Child Will Be Attending in 2010-2011: ____________________ Grade: __________

Parent/Guardian #1: __________________________________________________________

Address: ____________________________________________________________________

Phone: ________________ Cell Phone: _________________ Work Phone: _____________

Parent/Guardian #2: __________________________________________________________

Address: ____________________________________________________________________

Phone: ________________ Cell Phone: _________________ Work Phone: _____________

Emergency Contact (Name /Phone): _____________________________________________

PARENT EMAIL ***: __________________________________________________________

*** NOTE: Your registration receipt, health form, lunch menu, program schedule and specifics will all be sent via email!

______________________________________________________________________________

(Parent Signature) (Date)

(OVER)

COURSE SELECTIONS/DATES:

STUDY SKILLS

____ July 26^th - July 30^th 8:00am – 11:00am

____ August 2^nd - August 6^th 12:00pm – 3:00pm

____ August 9^th – August 13^th 8:00am - 11:00am

*Snack Included

____$105 (current/incoming NC students)

____$110 (non-NC students: must be entering grades 7 or 8)

Deposit $55 _____ or Paid in Full: __________

Remaining Balance (due 1 week prior to start date): ___________

JUNIOR HIGH SUCCESS

____ July 26^th - July 30^th 12:00pm – 3:00pm

____ August 2^nd - August 6^th 8:00am – 11:00am

____ August 9^th – August 13^th 12:00pm - 3:00pm

*Snack Included

____$105 (current/incoming NC students)

____$110 (non-NC students: must be entering grades 7 or 8

Deposit $55 _____ or Paid in Full: __________

Remaining Balance (due 1 week prior to start date): ___________

*** Students who register the SAME WEEK for BOTH, a morning and afternoon course from any Summer Stars program, may join us for lunch (which is provided or bring your own) and activity time in between course sessions.***