Enrollment Form for St. Jerome Atrium, 2019-2020
Please complete this form and send your first tuition installment of $100 (checks should be made payable to "St. Jerome Academy" with "Atrium" in memo) to reserve your child's place in the 2019-2020 Atrium. If you are enrolling a second child, please fill out the form a second time -- one form per child.
Email *
Child's First Name *
Child's Last Name *
Child's Birthdate *
Class Section *
Level One is for children ages 3 years old through kindergarten (must be 3 by the end of October 2019) Level Two is for children in 1st through 3rd grade.
Previous Atrium Experience *
Please indicate how much previous Atrium experience your child has had. If your child has had both Level One and Level Two experience, please check both boxes as appropriate.
School *
Grade *
Please select your child's grade level.
Sacramental Preparation *
Please indicate which response best describes your child's status with respect to having made First Confession and First Holy Communion.
Parent's Title *
Parent's First Name *
Parent's Last Name *
Primary Phone *
Emergency Contact *
Please provide the name and phone number of at least one emergency contact other than the parent listed above.
Pickup Person
Please provide the name and phone number of any person(s) you designate to be able to pick up your child from Atrium.
Special Needs
Please provide information about any special learning or medical needs your child might have.
Medical Instructions *
Please check all that apply.
A copy of your responses will be emailed to the address you provided.
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