Saint Mary's College High School Summer Programs Registration Form

Please use a separate registration form for each student. Additional forms may be downloaded from the Saint Mary’s website

(http://saintmaryschs.org) and are available in our main office. Student Information: Student name: _________________________________________________________________ School attended in 2013-2014: _______________________________________________ Grade level in 2013-2014: ______________________________________ Gender: M F Contact Information: Parent/Guardian Name: _________________________________________________________ Street Address: ________________________________________________________________ City/State/Zip: _________________________________________________________________ Email: ______________________________ Home Phone: _____________________________ Work Phone: ___________________________ Cell Phone: ___________________________ Emergency Contact Name and Phone: ____________________________________________ Alternate Emergency Contact Name and Phone: ____________________________________ Contact to Treat Waiver: I/We, the undersigned parent(s) or guardian(s) of ____________________________________ hereby authorize the directors of the Saint Mary’s College High School Summer Programs to act for me/us according to their best judgment in an emergency requiring medical attention. I/We hereby grant permission for my/our child to participate in the program and acknowledge that s/he is physically able to participate in program activities and hereby waive and release the school and its program personnel from any and all liability for any injuries or illnesses incurred in that participation. I/We hereby acknowledge that my private insurance will be the primary insurance coverage during my child’s participation in the Saint Mary’s College High School Summer Programs Insurance Carrier and Policy Number: ______________________________________________________ Parent/Guardian Signature: ____________________________________ Refund Policy Before May 1st: Refund of fees, less a processing fee of $50. Between May 1st and May 31st: Refund of fees, less 25% of course price or the processing

fee of $50, whichever is greater. No refunds will be processed after May 31st. Refund requests must be made in writing to the address on the reverse side of this form. For questions please contact: Catherine Mahoney, Director of Summer Programs, at cmahoney@stmchs.org.

Course Registration: Please select the courses you would like and circle the appropriate price category and write in your course price. For course descriptions, dates and times, please see our website

Single Course: For students enrolling selecting one course or camp. Multi-course/multi-camp: For students enrolling in more than one course or camp and for families enrolling more than one child.

Single Course Multi-Course Middle School Program Panther Preview $480 $432 Sports Starter $400 $360

Panther Prep: Saint Mary’s Class of 2018* Grammar Intensive $175 $156 Panther P.A.W.S. $225 $203 Writing Workshop $375 $338 Panther Power: Sports Camps Baseball Camp Full Day $200 $180 Baseball Camp Half Day $150 $135 Basketball Camp Full Day $200 $180 Basketball Camp Half Day $150 $135 Freshman Fitness Fun $350 $315 Golf Camp $350 $315 MS Basketball for Girls $150 $135 Soccer Camp $175 $156 Volleyball Camp $150 $135 Total Course Fees: _________ _________

For Single For Multi-Course Course Enrollment Discounts Please submit registration forms and fees (payable by check made out to Saint Mary's College High School) to:

Summer Programs Registration Attn: Catherine Mahoney Saint Mary's College High School 1294 Albina Avenue Berkeley, CA 94706

*If you are selected for a restricted program for members of the Class of 2018, you will need a registration form specific to that course and it will be provided to you; if you need a replacement copy, just let us know! For questions please contact: Catherine Mahoney, Director of Summer Programs, at cmahoney@stmchs.org