Please make checks payable to St. Isaac Jogues Parents Club and mail your payment with this form to Julie Sliwinski, 21113 Madison Street, St. Clair Shores, MI 48081.

Name: _________________________________________________ Phone: ____________________

Email: _______________________________Any Allergies?_____________ Vegetarian?__________

Full-Day ($40): __________ ½ Day 9am-3pm ($20): ___________½ Day 3-9pm ($20): _____________

Request to sit near: __________________________________________________________________ A confirmation email will be sent to you after receipt of payment! The event is non-refundable. St. Isaac Jogues reserves the right to cancel this event by March 23, 2013, if necessary. You will receive a full refund if the event is cancelled.