registration form

Math – ACT Workshop

  Cabrini High School March 22-25 3:30 - 6;00 pm

  Pope John Paul High School March 29 - 31 6:00-8:30 pm and April 1 3:30 - 6:00 pm

Pope John Paul II High School / Cabrini High School

Student Name __________________________________Grade___________

Contact Name (parent/guardian) ________________________________

Address_________________________________________________________

Phone Number ______________________________

Math course completed _____________________

ACT taken previously?_______________ Math ACT score* ____________

  (for statistics purposes only – privacy noted)

Email _______________________________________

  Check one with “X”

PJP Workshop $150.00 ( ) Cabrini Workshop $175.00 ( )

Parental Consent:

I hereby give permission for my child(ren) _________________________________________ to participate in this event. I agree to release, indemnify and hold harmless the Roman Catholic Church of the Archdiocese of New Orleans, PJP II/Cabrini Catholic H.S., and their members, officers, directors, administrators, officials, staff, employees, volunteers, insurers, and/or reinsurer hereafter “releases” from personal injury and /or property damage whatsoever, except for any such damage arising out of negligence of releases. I hereby also grant permission for my child to be treated by a licensed physical in the event of injury, illness, or other medical mishap.

Signed________________________________________________

Please return registration form with signed waiver and a check made to Christine Neely for $150.00 or $175.00 prior to the first day of the workshop.

Registration may be turned in to the PJP office

or mailed to : 208 Constellation Dr. Slidell, La 70458 Email: AMathPrep @gmail.com