Summer Enrichment Program 2021

SEP Application

The Summer Enrichment Program (SEP) serves young men who have finished the seventh grade and who are interested in enriching their education.

It will run from June 9 - June 30. During the program, students will be enriched academically, culturally, socially and physically.

The day begins at 8 a.m. and ends at 1 p.m. Participants are responsible for their own transportation to and from Saint Ignatius High School. Registration is $375. Two t-shirts and daily breakfast and lunch are included with the cost.

A credit card payment is required at the end of this form. If you have questions about payment, please contact Maryann Patrick in our Finance Department at mpatrick@ignatius.edu.

Please be aware that completing this form on a mobile phone may cause duplicate entries. Please complete the form on a desktop browser or tablet if available.

Student/Parental Application Form

Number of Students Registering for SEP

Student First Name

Student Last Name

Nickname or Name your son prefers to be called

Date of Birth

Current School

(2) Student First Name

(2) Student Last Name

(2) Nickname or Name your son prefers to be called

(2) Date of Birth

(2) Current School

(3) Student First Name

(3) Student Last Name

(3) Nickname or Name your son prefers to be called

(3) Date of Birth

(3) Current School

Race

Other Race

Favorite school subject

(2) Favorite school subject

(3) Favorite school subject

Favorite hobby/interest

(2) Favorite hobby/interest

(3) Favorite hobby/interest

Favorite sport

(2) Favorite sport

(3) Favorite sport

Address Line 1

Address Line 2

City

State

Postal Code

Parent/Guardian First Name

Parent/Guardian Last Name

Preferred Phone

Parent/Guardian Email

This will be the email we will use for all SEP communications.

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Preferred Phone

Parent/Guardian 2 Email

Carpooling: I allow our contact information to be released to other families in our area for carpooling purposes.

YesNo

If you check 'Yes', a listing of families from your area will be emailed toward the end of May.

How did you hear about SEP? (check all that apply)

Saint Ignatius WebsiteAdmissions eNewsletterPrint AdvertisementParish/School CommunicationSocial Media (Facebook, Twitter, Instagram)From a friend/current Saint Ignatius High School student

To Grant Consent

I hereby give permission for my son to attend the Summer Enrichment Program. I also consent for the following medical care providers and local hospital to be called:

Primary Physician

Phone Number

Dentist

Phone Number

Medical Specialist

Phone Number

Preferred Hospital

Insurance Provider

Insurance Policy Number

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by above-named doctor, or, in the event the designated preferred practitioner is not available, by another licensed physician or dentist: and (2) the transfer of the child to any hospital reasonably accessible.

This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity of such surgery, are obtained prior to the performance of such surgery.

I acknowledge that I have read and agree to the above.

I consent.

This form is complete and accurate, and the digital signature is that of the parent/legal guardian of the student above.

I agree.

Name of Parent/Guardian

Signer's Address

Billing and Payment

Billing Address

First Name

Last Name

Address Line 1

Address Line 2

City

State

Postal Code

Payment Information

Dollar Amount

$

Name on Card

Card Number

MM

YY

Code

Billing Email

Cybersource_Hidden_Fields