School Year for which you are Enrolling: 20______/20______Student’s Grade: ______
First Name: ______Today’s Date: ______
Last Name: ______Gender (circle): Male Female
Middle Name: ______Birth date: ______
Address: ______Birthplace: ______
City, State, Zip: ______
Home Phone: ( ) Preferred name (if applicable) ______
School Presently Enrolled: Name ______City/State ______
Ethnic Background (Check one – For Archdiocesan Purposes)
______American Indian ______Asian ______Bi-Racial
______Black (Non-Hispanic) ______Hispanic ______White (Non-Hispanic)
Religion (check one): ______Catholic
______Non-Catholic (List denomination: ______)
Baptism: Date ______Church ______City, State ______
First Communion: Date ______Church ______City, State ______
Reconciliation: Date ______Church ______City, State ______
Child lives with (check one): ______Mother ______Father ______Both
______Other (Whom?______)
Does your child have special needs, a history of special services,
public school or private evaluations, or medical conditions/allergies? (circle) YES NO
If yes, please explain. ______
Transportation: Please circle Yes or No for each question.
Do you live 1.5 miles or more from the school? YES NO
Do you/will you usually walk to our school? YES NO
Do you/will you usually ride the bus to our school? YES NO
Do you/will you usually drive/car pool to our school? YES NO
Do you/will you live within Arlington Heights School District #25? YES NO
If no, what district? ______
Name of public school for your residence: ______
FATHER
First Name: ______
Preferred Name: ______
Last Name: ______
Address: ______
City, State, Zip: ______
Home Phone: ______
Cell Phone: ______
E-mail Address ______
Occupation: ______
Employer: ______
Work Phone: ______
Religion: ______
Birthplace: ______
(City, State)
Marital Status ______
Stepparent’s/Guardian’s Name (if applicable)
MOTHER
First Name: ______
Preferred Name: ______
Last Name: ______
Address: ______
City, State, Zip: ______
Home Phone: ______
Cell Phone: ______
E-mail Address ______
Occupation: ______
Employer: ______
Work Phone: ______
Religion: ______
Birthplace: ______
(City, State)
Marital Status ______
Maiden Name: ______
______
Are you a registered parishioner of OLW Church? (Circle) YES NO
If yes, list parish envelope number: ______
I agree to have my child(ren) photographed for print/media releases. YES NO
Student Name:
Please indicate your first and second choices with a #1 and a #2 for preschool or kindergarten.
Thank you
Preschool
______Multi-age ~ 5 day ALL DAY program (Monday through Friday) (8:30-3:00)
(3 & 4 year-olds)
______3 year olds ~ 2 day morning program (Tuesday and Thursday) (8:30-11:00)
______3 year olds ~ 3 day morning program (Monday, Wednesday and Friday) (8:30-11:00)
* Child must be 3 years old prior to September 1st of the school year in which the child is being enrolled.
______4 year olds ~ 4 day morning program (Tues, Wed, Thurs, Fri) (8:30-11:00)
______4 year olds ~ 5 day morning program (Monday through Friday) (8:30-11:00)
* Child must be 4 years old prior to September 1st of the school year in which the child is being enrolled.
Preschool – Pray and Play
Pray and Play is available to all half day students. The extended day runs from 11:00-12:45. Students are required to bring their own lunch to Pray and Play. Families may sign up for one or more days a week at an additional yearly fee for each day of the week attended. Sign up for extended day now to reserve your spot. You may add on the extended day option at any time during the year provided space is available. The cost will be prorated for anyone joining after the first day. Please indicate the days of the week in which you would like to register for the extended day program. A minimum of 6 students is required for the extended day class to run on any given day.
______Monday (11:00-12:45) ______Tuesday (11:00-12:45)
______Wednesday (11:00-12:45) ______Thursday (11:00-12:45)
______Friday (11:00-12:45)
Kindergarten
______Full Day (8:20-3:05)
______Half Day Mornings (8:20-11:15)
______Half Day Mornings (with a full day once/week - Wednesday)
* Child must be five years old prior to September 1st of the school year in which the child is being enrolled.
Students may be dropped off at 8:00am when the rest of the students arrive.
Our Lady of the Wayside School
Thank you for your interest in Our Lady of the Wayside School. We appreciate the opportunity to work with you to educate your child in faith and knowledge. Registered and active OLW parishioners have priority on any available places in preschool through 8th grade.
Our Lady of the Wayside School is operated under the auspices of the Catholic Bishop of Chicago, a corporation sole, in the Archdiocese of Chicago. OLW admits students of any race, color, sex, national and ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students in this school. OLW does not discriminate on the basis of sex, race, color, or national and ethnic origin in administration of educational policies, loan programs, athletic or other school-administered programs.
All students admitted must comply with State of Illinois dental, vision, health examination and immunization requirements.
The Principal and Pastor will make final determination of admission and registration of a student based, in part, on the priority scale and established procedures.
In addition to the registration form, we do require the following:
· a certified birth certificate issued by the county/state (not by the hospital)
· a baptismal certificate
· cash, check, or money order for the registration fee
The State of Illinois requires documentation of the following:
· a physical exam by a licensed physician in Illinois, as well as a record of updated immunizations for all students entering school for the first time (including preschoolers), kindergartners and sixth graders BEFORE the first day of the current school year.
· An oral health examination by a licensed dentist in Illinois for all kindergartners, 2nd graders, and 6th graders due by May 15th of the current school year.
· a complete vision exam by a licensed optometrist or ophthalmologist in Illinois for students entering an Illinois school for the first time (not including preschoolers) and all kindergartners due no later than October 15th of the current school year.
Tuition Payment Plan Options:
Annual Plan: This is a one time payment due in July or August.
Semi-Annual Plan: This plan has 2 payments. The first payment is due in July.
Quarterly: This plan has 4 payments starting in July.
Monthly Plan: This plan has 11 payments starting in July.
Tuition billing and collection is managed by SMART TUITION. Registration information for SMART TUITION will be sent out at a later date and all families are required to register with them.
There is a $150.00 PER STUDENT registration fee WHICH MUST ACCOMPANY THIS FORM. Your registration fee will only be refunded in the event that you move out of town or are unable to secure a position in our school.
Note: this completed form, along with your registration fee payment, completes Step #1 of your registration. You will be contacted at a later date to establish your payment schedule.
(keep this sheet for your information)