Registration 2016-2017

St. Patrick Catholic School is a faith-based environment that offers a rigorous academic curriculum focused on the student’s present and future success.

Student’s Name______Age______Grade entering______Gender ______

Child’s Home Address______

StreetCityZip Code

Home Number______

School Last Attended ______

(Include name of school and city/state)

Date of Birth______Birthplace______Social Security Number______

(Month/Day/Year)

Mother______Religion______

Place of Birth ______Place of Employment______

Work Phone______Cell Phone ______

Email Address______

Father ______Religion______

Place of Birth ______Place of Employment______

Work Phone______Cell Phone ______

Email Address______

Child living with: Both Parents______Mother______Father______Legal Guardian ______Other ______

Please provide additional information below if applicable

Custodial Parent______Phone______

Non-Custodial Parent______Phone______

Step-Parent______Phone______

Allergies: ______Physical/Medical Concerns: ______

Medication: NO______YES______Name/Time of Medication:______

NO Medication can be given without signed parent permission AND a signed doctor’s order.

Hospital Preference: St. John’s______Memorial______

I wish to enroll my child in St. Patrick Catholic School. Parent/Guardian Signature/Date______

Please read and initial each statement and sign below to complete the registration process.

Name of Student______

  1. Please include______do NOT______include my child in any interviews, photographs, or website(s) in respect to school news stories or instructional/informational projects/programs. _____Please initial
  1. I understand that the Family Handbook can be found online at or by request by contacting

the school office. _____Please initial

  1. I understand that my child shall wear his/her uniforms. Staff may impose consequences if uniforms are not worn.

_____Please initial

  1. I understand that it is a privilege to use a computer at St. Patrick Catholic School as outlined in the Internet Use Policy, located in the Family Handbook. I understand that if my child does not use the school computer appropriately, that he/she may lose such a privilege. ______Please initial
  1. I understand that as per diocesan policy that I must provide the school a copy of my medical insurance card or my child may not attend St. Patrick Catholic School. ______Please initial
  1. I understand that the school must have a CERTIFIED copy of my child’s birth certificate and mostUP to DATEimmunization records on files. In addition, I understand that there are state mandated health requirements that

must be met as per the school code (vision, dental and physical). ______Please initial

  1. I understand that St. Patrick Catholic School participates in the CEO (Community Eligibility Option) through the National School Lunch Program; therefore, all students receive free meals as part of the program. ______Please initial
  1. I understand that my child (kindergarten through 5th grade) must be dropped off by 8:15 a.m. (no later than 8:10 for breakfast) and must be picked up by 3:40 p.m. If I am late picking up my child, my child will be sent to the aftercare program, at a rate of $12.00 per day/per child. I will be responsible for these fees.

______Please initial

  1. I understand that the school offers a pre-school and an aftercare program, accepting private pay or Community Child Funds.

I am responsible for fees or copayments, if my child attends this program. The program closes at 5:30 p.m. If the school closes for inclement weather, the aftercare/preschool program will remain closed. ______Please initial

  1. I understand that I may receive email or text reminders from St. Patrick Catholic School. ______Please initial

My preferred email is______.

My preferred cell number for text is______.

  1. I have received a copy of the Tuition Payment Contract, and I understand that if payments are not received as detailed in the contract that my child may be asked to leave St. Patrick Catholic School. ______Please initial

As per the diocesan policy, St. Patrick Catholic School admits students of any race, color, national and ethnic origin, or gender to all the rights, privileges, programs and activities generally accorded or made available to students at the school. It does not discriminate on the basis of color, race, national or ethnic origin, or gender in administration of its educational policies, admission policies, scholarships and loan programs, or athletic or school-administered programs.