Summer Program Registration

Welcome to the 2016 Summer Program Registration page!

Please refer to our 
Program Brochure for full course descriptions and Summer Program Policies and Procedures.

UPDATE - May 19, 2016

The following courses are now FULL and are no longer accepting registrations:

  • Ready, Set, Go! Algebra 1 - AM Session
  • Ready, Set, Go! English 9 - AM Session
  • Study Skills

Space is limited, so register today! Please call 503-721-7725 for more information.  

Summer Program Registration

Course 1 (choose):

Course 2 (optional):

Course 3 (optional):

Student Name: 

Current School: 

Entering Grade: 

Gender: 

Mailing Address: 

City, State and Zip: 

Parent Email Address (required for all correspondence): 

Emergency Information

Parent(s)/Guardian: 

Cell Phone: 

Work Phone: 

Media Release

Occasionally we take photos or video footage during class for use in our catalog and other public media.  Do we have your permission to use your child's image? 

Emergency Medical Information Release

I hereby authorize the staff of St. Mary's Academy Summer Program to act for me according to their best judgment in any emergency requiring medical attention.  I hereby waive and release the St. Mary's Academy Summer Program staff from any and all liability for any injuries sustained by my child while at camp.  I have no knowledge of any physical impairment that would be affected by the above named child's participation in this program. *Please send any special needs, dietary restrictions, or allergies that you feel we should be aware of to summerprogram@smapdx.org.

Emergency Contact: 

Emergency Contact Phone: 

Medical Insurance Carrier:

Policy Number:

Parent/Guardian Name (Signature): 

 



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