St. Thecla School Registration 2017-2018

Date:______

ST. THECLA SCHOOL REGISTRATION 2017-2018

Student Family Name (LAST only – Please Print):______

Father’s Full Name:______Mother’s Full Name:______

Student Address:______City:______Zip:______

Home Phone: ( )______Email Address:______

Father’s Cell: ( )______Mother’s Cell: ( )______

Parent Marital Status: Married Single Divorced Separated Widowed

Individual Responsible for Tuition: Father Mother Both Other:______

Registered at St. Thecla Parish: Yes No – Please name parish:______

Are parents St. Thecla alumni? Yes No Older sibling graduates of St. Thecla? Yes No

Residing School District?______

Race: Caucasion American Indian African-American Asian Hispanic

Pacific Islander Other:______

Religion of parents:______Religion of child/ren:______

Baptized: Yes No

Referred by current St. Thecla Family: No Yes – Family Name:______

CHILDREN ATTENDING ST. THECLA SCHOOL

Preschool – Full Name:______Gender:______DOB:______

3 Year Program 4 Year Program 5 Day Half / Full 3 Day Half / Full 2 Day Half / Full

Accept other session if 1st choice is not available? Yes No

If yes, please specify 2nd choice:______

Kindergarten – Full Name:______Full/Half Day Gender:______DOB:______

Full Name:______Grade in 2017-18:______Gender:______DOB:______

PLEASE INCLUDE MY INFORMATION IN THIS YEAR’S DIRECTORY: Yes No

Non-refundable Registration Fee: $175 per preschool only family (if registered on or before February 17, 2017, a $25 discount applies). $275per K-8 family ($75 discount if registration is received on or before February 17, 2017, $50 discount if received by March 1, 2017). Registration Fee will only be accepted if previous balances are paid in full. BIRTH CERTIFICATES, IMMUNIZATION RECORDS, BAPTISMAL CERTIFICATESMUST

ACCOMPANY THIS FORM IF REGISTERING A NEW STUDENT.

Date:______Cash:______Check No:______Initials:______

FINAL ENROLLMENT BASED UPON ADMITTANCE REQUIREMENTS

EMERGENCY CONTACT INFORMATION

PLEASE PRINT & COMPLETE ALL REQUIRED FIELDS

______( )______

Father’s Name Address (if different than student Home Phone

______( )______( )______

Place of Employment/Occupation Work Phone Cell Phone

______( )______

Mother’s Name Address (if different than student Home Phone

______( )______( )______

Place of Employment/Occupation Work Phone Cell Phone

With Whom Does Child/ren Reside?______

Legal Guardian:______

Address:______City/State:______Zip:______

Home:( )______Work:( )______Cell:( )______

If parent(s) cannot be reached in an emergency involving an illness or accident, please contact the following person(s):

1.______

Name Street Address City

______( )______( )______( )______

Relationship to Student Cell Phone Home Phone Work Phone

2.______

Name Street Address City

______( )______( )______( )______

Relationship to Student Cell Phone Home Phone Work Phone

Please list any student physical or medical conditions:

Student Name:______Medical Condition, i.e. allergies, etc.______

In the event that my child/ren is/are injured and I cannot be reached , school personnel are hereby authorized to take my child/ren to a nearby physician or hospital for emergency care. I agree to assume all expenses.

______

Parent/Legal Guardian Signature

FINANCIAL AGREEMENT: I understand my financial obligation with respect to my child’s attendance at St. Thecla School and agree to accept responsibility for the tuition payments. Also, I have received a copy of and understand the tuition refund policy and participating parishioner guidelines.

______

Parent/Legal Guardian Signature

PLEASE DO NOT FOLD THIS FORM