SAINT EDWARD SCHOOL
N2944 State Road 47, Appleton, WI 54913

920-733-6276

2017-2018 Registration Form

STUDENT INFORMATION
Student Name (Last, First, Middle)
NOTE: Students who are re-registering only need to complete data in STUDENT INFORMATION that has changed since last recorded. At least One Financial Responsibility Form and Signatory Acceptance Form must be returned each year.
Student Date of Birth / Student Gender
Male Female / School District Child Resides In
Student Registering for Grade: / If PK-3 or 4K: (Choose all that apply)
3K Tue, Wed, Thur am only (8:00 am – 10:30 am)
3K Tues, Wed, Thur full day (8:00 am – 3:00 pm)
4K AM or PM session
4K Extended Day (11:00 am – 3:00 pm)
4K Friday (All day)
Student Religious Affiliation
If Catholic, name of church where you are registered
Has Student been Baptized?
Baptism Date, if applicable / Baptism Location, if applicable
Has Student received First Holy Communion?
Date / Location
Student Race/Ethnic Origin

White, Non-Hispanic Hispanic Asian/Pacific Islander Black/Non-Hispanic
Multiracial American Indian/Alaskan Other
Student’s Siblings
Name / Date of Birth / School
FATHER/GUARDIAN INFORMATION
NOTE: One FATHER/GUARDIAN and MOTHER/GUARDIAN page may be submitted per FAMILY, if same information.
Father/Guardian’s Name (Last, First, Middle)
Home Address, if not the same as Student (Number, Street, City, State, Zip
Home Phone / Cell Phone / Work Phone
Email Address
Employer Name / Occupation
Religion / Parish
Father/Guardian (Please Check All that Apply)
Live with Student List Home/Cell Phone in School Directory Authorized Emergency Contact

Custodial Rights Receive Weekly News Family Folder Authorized to Pick Up Student
MOTHER/GUARDIAN INFORMATION
Mother/Guardian’s Name (Last, First, Middle)
Home Address, if not the same as Student (Number, Street, City, State, Zip
Home Phone / Cell Phone / Work Phone
Email Address
Employer Name / Occupation
Religion / Parish
Mother/Guardian (Please Check All that Apply)

Live with Student List Home/Cell Phone in School Directory Authorized Emergency Contact

Custodial Rights Receive Weekly News Family Folder Authorized to Pick Up Student
EMERGENCY INFORMATION
NOTE: One EMERGENCY INFORMATION and MEDICAL TREATMENT RELEASE must be submitted for each STUDENT.
Provide the name(s) of individual(s), other than parents, allowed to pick up the student.
Name (Last, First)
Home Phone / Cell Phone / Relationship to Student
Name (Last, First)
Home Phone / Cell Phone / Relationship to Student
MEDICAL TREATMENT RELEASE
Primary Doctor / Phone Number
Dentist / Phone Number
Insurance Carrier / Policy Number
I,______(Parent/Guardian), give St. EdwardSchool and its designated representative permission to transport and sign all forms related to the necessary medical treatment for ______(Child). I also permit any and all required medical treatment to be administered by qualified medical personnel, including calling 911.
Signature of Parent/Guardian / Date
List any/all medication student is taking:
List any/all known allergies, including food and medicines:
Please indicate any special needs or information necessary to ensure the appropriate medical attention is provided:
FINANCIAL RESPONSIBILITY
2017-2018Tuition
*Application for a Financial Scholarship is available for families in need.
GRADE / DAYS PER WEEK / ANNUAL COST
Cost per full time student / $4000+
Parish investment per student / $1720
PreK3-year old class
(Tues/Wed/Thurs) 8:00-10:30 a.m. / 3 / $1200
PreK3-year old all day
(Tues/Wed/Thurs) 8:00-3:00 p.m. / 3 / $2200 ($3 an hour)
4-year old Kindergarten AM or PM session (M-Th) / 4 / All students open enroll through Hortonville School District.
Extended Day 4K
(11 a.m.--3 p.m.) / 4 / $1900 ($3.60 an hour)
Friday 4K (all day) / 1 / $1000 ($3.90 an hour)
Kindergarten -Grade 5 / 5 / $2000 ($1900 for multiple students)
Payment Plan– All tuition to be paid in full by May 31, 2018.
(Please Check One)
Monthly Payments(x9) / Quarterly Payments (x4)
Semi-Annual Payments (x2) / Annual Payment (x1)
2017-2018 Fundraising
Third Source Fundraising Goal: SCRIP Family fee--
$100/student or $250/family for full time students
$50/student for part time students (PreK-3 and 4K extended day)
as well as participation in Fish Fry and Harvest Moon Festival Community Fundraisers.

NOTE: The Scrip Program offers another way to earn toward your tuition. Scrip is available after weekend masses and in the school office during school hours.

SIGNATORY ACCEPTANCE
NOTE: At least one SIGNATORY ACCEPTANCE must be submitted for each FAMILY.
I,______(Parent/Guardian), am responsible for ______% of the payment of the registration fee, tuition and fundraising requirements for:
Student Name / 2016-2017 Grade
All fees and tuition will be paid in full by May31, 2017. If, for any reason, I want to change the payment plan or
fundraising option, I will call the School Office for a new form.
Signature of Parent/Guardian / Date