Enrollment Form 2021-2022

Enrollment Form for 2021-2022

Please complete the form below. Required fields marked with an asterisk *

STUDENT INFORMATION:

Grade Applying for 2021-2022 School Year*

Answer Required

First Name*

Answer Required

Middle Name*

Answer Required

Last Name*

Answer Required

Date of Birth*

Answer Required

Age:*

Answer Required

Male or Female*

Answer Required

Male

Female

Address:

Street Address*

Answer Required

City*

Answer Required

Zip/Postal*

Answer Required

Religion*

Answer Required

Parish/Church Affiliation*

Answer Required

Baptized Catholic*

Answer Required

Yes

U.S. Citizen*

Answer Required

Yes

Ethnicity (for statistical purposes only)*

Answer Required

Current School (Name, City, State, Phone)*

Answer Required

Current Grade*

Answer Required

Student lives with:*

Answer Required

Mother and Father

Mother only

Father only

Legal Guardian

*All divorced parents are required to furnish school with copy of custody section of the divorce decree.

*All legal guardians are required to furnish school with a copy of the court document.

PARENT/GUARDIAN 1

Relationship to student*

Answer Required

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Occupation and Employer*

Answer Required

PARENT/GUARDIAN 2

Relationship to Student*

Answer Required

First Name*

Answer Required

Middle Name

Answer Required

Last Name*

Answer Required

Email 1*

Answer Required

Mobile Phone*

Number Required

Home Phone

Number Required

Work Phone

Number Required

Occupation and Employer*

Answer Required

Please list siblings of student and their ages:

Answer Required

Please list any medical conditions or allergies of which St. Patrick School should be made aware:*

Answer Required

AUTHORIZED FOR PICKUP:

Other than parent or legal guardian, please list names, relationship and contact number of those authorized to pickup student from school:*

Answer Required

TUITION INFORMATION:

After Hours (Please indicate if you plan to utilize After Hours Care)*

Answer Required

Yes

Mandatory Fundraiser (Please indicate if you plan to opt out and pay the fee of $60.00)*

Answer Required

Opt Out

Participate

Please indicate if applying for free/reduced lunch application (available in summer)*

Answer Required

Yes

Dyslexia Therapy (Please indicate if you are interested in this service for an extra fee)

Answer Required

Yes

I understand that the principal must conduct a family (parent and child) interview to determine acceptance to St. Patrick Catholic School.

I understand that if my child is accepted to St. Patrick Catholic School that enrollment is not complete until the receipt of the non-refundable/non-transferable registration fee, copy of birth certificate, immunization form No. 121, and Baptismal certificate (for Catholic parishioners to receive Catholic tuition rate).

I also understand that if my child is accepted, the first 90 days of his/her attendance at St. Patrick Catholic School is a probationary period.

Signature*

Answer Required

Date:*

Answer Required

In accordance with the Civil Rights Act of 1964, there will be no discrimination on the grounds of race, creed, color, national origin or handicapping condition in regards to student enrollment or staff employment.

Please fix the highlighted areas below before submitting.

Enrollment Form 2021-2022