St

St. Mary’s Catholic School

Pre-K Registration

2008-2009

Please complete every item on this form in clear printing.

Choose a session:

3 year old Tuesday & Thursday~ AM session (9:00-11:30) $1220 per year
4 year old Monday, Wednesday, Friday~AM session (9:00-11:30) $1420 per year
4 year old Monday, Wednesday, Friday~ Full session (9:00-2:00) $2720 per year

Name of child:_______________________________________________________________________________

Date of birth:__________________________ M_____ F_____ Social Security #_______________________

Home Phone_________________________________

Home Address:______________________________________________________

City____________________________________________State_________________Zip____________________

Child lives with: (please circle) Both Parents, Mother, Father, Other __________________________

(Relationship)

Father’s Information:

Last Name: __________________________________________First name_____________________________

Address (if different)________________________________________________________________________

Home phone________________________________

Employer’s Information: Job Title_____________________________________________________________

Company Name:_____________________________________________________________________________

Street Address:______________________________________________________________________________

Daytime Phone:_______________________________Extension__________Cell________________________

E-Mail_______________________________________________

Mother’s Information:

Last Name: _________________________________________First Name____________________________

Maiden Name:______________________________________________________

Address (if different)________________________________________________________________________

Home phone_____________________________________

Employer’s Information: Job title:_____________________________________________________________

Company Name:_____________________________________________________________________________

Street Address:______________________________________________________________________________

Daytime Phone ___________________________Extension _____________Cell________________________

E-mail________________________________________________

Caregiver Information:

Name:_______________________________________________________________________________________

Phone__________________________________Cell________________________Pager____________________

Are there any food allergies, nervous habits, disturbing experiences, or physical disabilities that the teacher should be aware of?______________________________________________________________

_____________________________________________________________________________________________

Would you be able to help out on occasion for special class parties or field trips?_______________

Please list all other siblings and the schools they attend:

Name__________________________________________Grade_________School_______________________

Our primary means of communication will be e-mail. Please provide your e-mail address.

_________________________________________________

We do not have e-mail, please provide paper copies of all correspondence.

The $50.00 registration fee and $40.00 tuition application fee must be paid at the time of registration. If we are unable to accept your child, the fees will be refunded.

Your child will not be able to attend unless fully toilet trained.

I have read the new tuition guidelines and agree to the conditions.

X ________________________________________________________Date____________________________

Parent Signature

Office use only below this line:

Date registration received_______________ #______

____Reg Fee _______Ck #

____Tuition form _______Ck #

_____Birth Certificate

_____Health Packet returned