Please Print or Type

Applying for:   Preschool   ___AM     ___PM

                                         ___2 Days___3 Days ___5 Days

                      Kindergarten ___AM    ___PM

                      Elementary   ___1^st      ___2^nd      ___3^rd      ___4^th     ___5^th

                      Middle          ___6^th     ___7^th       ___ 8^th 

Date ________________

Student Name:

Last__________________ First_________________ Middle_____________

Age____ Date of Birth__________ Place of Birth_______________________

Social Security #__ __ __ - __ __- __ __ __ __

Address_______________________________

City____________________________ Zip_________________

Phone (include area code)___________________________

Subdivision_________________________

Ethnic Background:

___American Indian              ___Asian                         ___Hispanic         

___Black non-Hispanic         ___Anglo non-Hispanic    ___Other

Religious Preference_____________________ Parish___________________

Parishioners of St. Mary Church, Envelope Number ____________________

Non-Catholic students are welcomed at St. Mary School but must understand that all students will attend the religious activities that are held during the school day.

Parents:

Father/Guardian________________________Religion__________________________

Occupation_____________________ Place of employment_______________________

Work Phone________________________   Cellular Phone_______________________

Email address ________________________________________

Mother/Guardian_______________________ Religion__________________________

Occupation_____________________ Place of employment_______________________

Phone__________________________ Cellular Phone___________________________

Email address __________________________________________

Child lives with_____________________________

Public school child would attend if not at St. Mary School_______________

Student Information:                

Baptism:             

Church_____________________________________________________

Date_______________________________________________________

City/ State__________________________________________________

Communion:

Church_____________________________________________________

Date_______________________________________________________

City/ State__________________________________________________

Referred to St. Mary School by___________________________________

All new students are admitted on a Trial Basis.

All students are admitted to our program based on complete and accurate reporting of records.   St. Mary School reserves the right to select students whose needs we can accommodate.

All fees are due on the first of each month or a late fee will be assessed.

Tuition credit will be given for families who refer someone to St. Mary School.   One month’s free tuition will be given for each new family that is referred by you to St. Mary School.   The family referred must be in attendance for you to receive the tuition credit.

                                                                   Office use only

                                                                   RF____Class_____

                                                                   C  NC  P  NP