St. Mary Schools Registration Application
All new students applying for admission at St. Mary for the 2017-18 school year should complete the form below. New students will need to provide the additional paper documents and registration fee to complete the application. A list of those documents can be found by visiting www.smss.org/admissions/registration.
Father/Guardian Information
Please indicate relationship to student(s)
First Name
Your answer
Last Name
Your answer
Address
Your answer
City, State and Zip
Your answer
Home Phone
Your answer
Work Phone, Ext.
Your answer
Cell Phone
Your answer
Email
Your answer
Occupation
Your answer
Employer
Your answer
Mother/Guardian Information
Please indicate relationship to student(s)
First Name
Your answer
Last Name
Your answer
Address
Your answer
City, State and Zip
Your answer
Home Phone
Your answer
Work Phone, Ext.
Your answer
Cell Phone
Your answer
Email
Your answer
Occupation
Your answer
Employer
Your answer
School Registration
Please complete information on the new student(s) in your family who will be attending St. Mary School System. PRESCHOOL PARENTS MUST ALSO COMPLETE THE DAY/TIME FORM which can be found at www.smss.org/admissions/registration.

If enrolling more than 3 children, please complete a second on-line registration form.

1. Student Name: First Name, Middle Name
Your answer
Last Name
Your answer
Gender
Your answer
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Your answer
Grade Entering 2017-18 (P-12)
Your answer
Public School According to Residence
Your answer
Ethnicity (please mark if applicable)
Race: (Please mark all that apply)
Required
2. Student Name: First Name, Middle Name
Your answer
Last Name
Your answer
Gender
Your answer
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Your answer
Grade Entering 2017-18 (P-12)
Your answer
Public School According to Residence
Your answer
Ethnicity (please mark if applicable)
Race: (Please mark all that apply)
3. Student Name: First Name, Middle Name
Your answer
Last Name
Your answer
Gender
Your answer
Date of Birth
MM
/
DD
/
YYYY
Social Security Number
Your answer
Grade Entering 2017-18 (P-12)
Your answer
Public School According to Residence
Your answer
Ethnicity (please mark if applicable)
Race: (Please mark all that apply)
Religious Affiliation
Your answer
Regardless of Religious Affiliation, please select one of the options below for which parish you are a member:
Required
If attending another Catholic Parish not listed above, please specify:
Your answer
Divorced and/or separated parents MUST have a copy of the divorce decree verifying custody arrangements on file with the school office.
Who is the custodial parent?
Your answer
May child(ren) be released to non-custodial parent?
Emergency Information
Please check one: In case of an emergency
Required
Below list three (3) adults and their daytime phone numbers, to whom the school is authorized to release your child(ren)
1. Adult Name (First and Last)
Your answer
Phone Number
Your answer
Relationship to Student
Your answer
2. Adult Name (First and Last)
Your answer
Phone Number
Your answer
Relationship to Student
Your answer
3. Adult Name (First and Last)
Your answer
Phone Number
Your answer
Relationship to Student
Your answer
Emergency Medical Information
In case of serious illness or accident, the school will make every attempt to contact you.
Physician name and phone number
Your answer
Dentist name and phone number
Your answer
Hospital of Choice
Your answer
Please list any pertinent medication/treatments/allergies for each of your child(ren) below.
Your answer
Please mark your answer:
Please mark the box below to indicate that you have read and understand the policy below:
Required
I consent for St. Mary School System to use my child(ren)'s name(s) and photo(s) in news publications, on social media, or on marketing materials.
By submitting this registration form, I hereby warrant to St. Mary School System and/or After School Program that I am entitled to legal custody and possession of my child and am authorized to complete this form. Additionally, I have read and understand this form. In consideration, I agree to hold harmless and indemnify the St. Mary School System and its employees against all injuries arising out of these arrangement.
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