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St. Mary's School 2018-2019 Enrollment
REGISTRATION IS NOT CONSIDERED COMPLETE UNTIL THE OFFICE RECEIVES $100 PER STUDENT FEE.
Last Name of Student *
Your answer
First Name of Student *
Your answer
Middle Name of Student *
Your answer
Date of Birth for Student *
Please submit in following format: mm/dd/yyyy
MM
/
DD
/
YYYY
Gender of Student *
Student First language spoken at home *
Religion *
Please select from the following choices for student
Student resides with - *
What grade will student be in for school year 2018-2019? *
Pre School 4 year Old (FULL)
Your answer
Pre School 3 year Old Time Preference
Address of Student *
(please use correct format. For County Road, please use Co Rd Please do not use characters or periods.)
Your answer
Name of City for Student *
Your answer
Zip code for Student *
Your answer
What school district do you reside in? *
Race/Ethniticity *
Required
Home Phone # for Student *
If there is not a home phone, please use a guardian cell phone
Your answer
Any known health concerns of Student *
If "No" health concerns please indicate with NA
Your answer
Guardian/Parent Information
St. Mary's Bingo (Preschool Families Only)
St. Mary's Bingo is one of the school's largest fundraisers. This weekly event takes many volunteers to run successfully. The school does mandate that each family have one volunteer work bingo. This is optional for families of preschool students. If you are a preschool parent, please indicate below if you are willing to volunteer to work bingo.
Please select at least one Volunteer Fundraiser *
Check all that you would like to help with
Required
Last name of guardian 1 *
Your answer
First name of guardian 1 *
Your answer
Guardian 1 relationship to student *
Guardian 1 Driver's License Number *
The Indiana State Gaming Commission requires all volunteers to submit their driver's license number and date of birth.
Your answer
Guardian 1 Date of Birth *
The Indiana State Gaming Commission requires all volunteers to submit their driver's license number and date of birth.
MM
/
DD
/
YYYY
Guardian 1 address *
Your answer
City of guardian 1 *
Your answer
Zip code of guardian 1 *
Your answer
Guardian 1 email address *
Your answer
Guardian 1 home phone # *
If no home phone please enter your cell number use the format of 812-000-0000
Your answer
Guardian 1 Cell Phone number
Your answer
Guardian 1 place of employment *
If there is not a place please indicate with NA
Your answer
Guardian 1 Work Phone #
Your answer
Guardian #2 Last name
Your answer
Guardian #2 First Name
Your answer
Guardian #2 Relationship to student
Guardian 2 Driver's License Number
The Indiana State Gaming Commission requires all volunteers to submit their driver's license number and date of birth.
Your answer
Guardian 2 Date of Birth
The Indiana State Gaming Commission requires all volunteers to submit their driver's license number and date of birth.
MM
/
DD
/
YYYY
Guardian #2 Cell phone #
please submitt as follows: 812-000-0000
Your answer
Guardian #2 email address
Your answer
Address of Guardian #2
Your answer
City of Guardian #2
Your answer
Zip Code of Guardian #2
Your answer
Guardian 2 place of employment
Your answer
Guardian 2 Work Phone #
Your answer
Emergency Contact Information Individual 1 (First and Last Name) *
Guardian #1 and Guardian #2 are already designated as Emergency Contact. Please include any other individual.
Your answer
Emergency Contact Individual 1 Phone # *
Your answer
Emergency Contact Individual 1
Relationship to student
Your answer
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