Summer Academics Registration

*Student’s First Name

*Student’s School

*Student’s Last Name

*Grade Going Into

*Gender

*Parent/Guardian’s First Name

*Parent/Guardian’s Last Name

*Mailing Address

*City

*State

*ZipCode

*Cell

Work

*Parent/Guardian’s Email

Emergency Contact Information

*Adult First Name

*Adult Last Name

*Relation to the Student

*Adults Cell

Adults Work

Alternative Contact

Alternate First Name

Alternate Last Name

Relationship to Student

*Alternative Cell

Alternative Work

*Please list all your child’s allergies

*If an emergency occurs, do we have your permission to take your child to the hospital?

Yes

Doctor’s Name

Doctor’s Phone

Preferred Hospital/Clinic

Commitment to Participation & Education

I acknowledge that I have received and read the Notre Dame Urban Education Center (NDUEC) Handbook. I understand and agree to comply with the policies, procedures, and expectations outlined in the handbook.

Registration Fee

I commit to paying the registration fee as part of the enrollment process and acknowledge it as an investment in my child/children’s education. I further understand that the registration fee is non-refundable.

*To complete the enrollment process, I agree to pay the registration fee by

Parent/Guardian Authorization

*My child will be picked up by

*Relationship to the Student

*Parent/Guardian signature

*Date

In the event that neither I nor the alternate contact listed above can be reached in an emergency, I authorize the attending physician to administer proper and necessary treatment for the safety of my child.

*Parent/Guardian signature

*Date

I grant permission to Notre Dame Urban Education Center (NDUEC) to photograph, videotape, and record my child during participation in NDUEC programs and activities. I authorize NDUEC to use these images and recordings for educational, promotional, fundraising, marketing, and public relations purposes, including print, website, social media, and other communications. I understand that no compensation will be provided and that this permission remains in effect unless revoked in writing. Any revocation will apply only to future use and not to materials already published.

*Parent/Guardian signature

*Date

Summer Academics Registration

Summer Academics Registration

Emergency Contact Information

Alternative Contact

Commitment to Participation & Education

Registration Fee

Parent/Guardian Authorization

The Sisters of Notre Dame

Our Center

Contact Info