HOLY NAME SUMMER SCHOOL APPLICATION

STUDENT'S NAME ________________________________________________

GRADE ENTERING IN SEPT. _________TELEPHONE #____________________________

MY CHILD IS PRESENTLY ATTENDING HOLY NAME SCHOOL: ____YES ___ NO

MY CHILD WILL BE ATTENDING HOLY NAME SCHOOL IN SEPTEMBER: ___YES ___NO

IF YOUR CHILD IS NOT PRESENTLY ATTENDING HOLY NAME SCHOOL, PLEASE FILL IN THE INFORMATION BELOW:

PARENT'S NAME: __________________________________

ADDRESS: _____________________________________

CITY: __________ STATE: ___________ ZIP:______________

SCHOOL PRESENTLY ATTENDING: ______________________________________

SCHOOL PHONE #____________________

PRINCIPAL'S NAME: _________________________

YES, I WISH TO ENROLL MY CHILD IN THE HOLY NAME SUMMER SCHOOL PROGRAM. ENCLOSED IS THE NON-REFUNDABLE $225 TUITION FEE.

(MASTER CARD AND VISA PAYMENTS ALSO ACCEPTED)

MASTER CARD OR VISA PAYMENTS ACCEPTED:

TYPE OF CARD: ______________

CARD NUMBER __________________________ EXP. DATE: __________

PARENT SIGNATURE:_________________________________________

[THE TUITION FEE MUST BE INCLUDED WITH THIS APPLICATION]