SNO@UU 25 Registration Form

Name of participant

Nickname

Age 5-12

Gender

Pronouns

Name of school

Grade in September (Kindergarten or above)

Parent/guardian #1

Email (parent/guardian #1)

Phone (parent/guardian #1)

Parent/guardian #2 (or alternate contact person)

Email (parent/guardian #2 or alternate contact person)

Phone (parent/guardian #2 or alternate contact person)

Address

Sessions you are registering for Week 1 (Aug 18th - 22nd) Week 2 (Aug 25th - Aug 29th)

Do you require Before or After care? (additional fee of $20 per day for Before Care, and $35 for After Care)

Yes No

How much will you pay on the sliding scale of $325 to $425 per week

A deposit of $100 towards your balance is required today

I understand that this registration and receipt of deposit will hold a place for my child in the summer program at First Parish Brewster UU. My non-refundable $100 deposit will be put towards the balance of the total fees. In order for my child to participate I will be required to fill out a Participant Information/Health and Consent Form before the start date. Yes

Payment

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Description

SNO@UU summer program registration form. Participant Information/Health and Consent forms will be sent along with an invoice when you register. A non-refundable $100 deposit is due at registration.

Program fees are on a sliding scale of $325-$425 per week. Scholarships will be available based on financial need.

The program runs 9-3 daily. Before-care from 8-9 can be added for $20 a day, and after-care 3-5 pm can be added for $35 a day.

SNO@UU 25 Registration Form

Description

Please Fix the Following