CTK Registration Form
Is this a *
Last Name *
Your answer
First Name *
Your answer
Middle Name *
Your answer
Student's Suffix
Your answer
Parent's First Name *
Your answer
Parent's Last Name *
Your answer
Parent/Guardian Suffix *
Parent/Guardian Relationship *
Parent/Guardian Salutation *
Custodial Parent *
Does the parent who resides with this student have sole or shared responsibility? *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
email *
Your answer
Job Title *
Your answer
Job Place *
Your answer
Home Phone *
Your answer
work Phone *
Your answer
Cell Phone *
Your answer
Would you like your information included in the school directory? *
Required
Parent/Guardian Religion *
Parent/Guardian - If Catholic, Church you Attend? If Non-Catholic, then N/A *
Your answer
Are you a Registered Member of Christ the King Church? *
(If yes, please return the PUT GOD FIRST form to the school office with registration fee) (one form per family) (If no, please return PARISH FAMILY AGREEMENT form to the school office with registration fee) (one form per family)
Parent/Guardian Contributing to Christ the King Church *
Parent/Guardian Envelope Number
Your answer
Parent/Guardian - Are you a CK Alumni? *
Parent/Guardian - If yes, year of Graduation?
Your answer
How do you intend to pay your tuition? (Please read all options and choose one) *
Please select the option for the Family Participation Plan *
Carl *
Your answer
Owens *
Your answer
Parent/Guardian 2 Suffix *
Parent/Guardian 2 Salutation *
Parent/Guardian 2 Relationship *
Parent/Guardian 2 Primary Custodial *
Does the parent who resides with this student have sole or shared responsibility? *
6662 Ovington Rd *
Your answer
Jacksonville *
Your answer
FL *
Your answer
32216 *
Your answer
Your answer
*
Your answer
Parent / Guardian 2 Business Name *
Your answer
Parent / Guardian 2 Home Phone *
Your answer
Parent / Guardian 2 Business Phone *
Your answer
Parent / Guardian 2 Mobile Phone *
Your answer
Would you like your information included in the school directory? *
Required
Parent/Guardian 2 Religion *
Parent/Guardian 2 - If Catholic, Church you Attend? If Non-Catholic, then N/A *
Your answer
Are you a Registered Member of Christ the King Church? *
(If yes, please return the PUT GOD FIRST form to the school office with registration fee) (one form per family) (If no, please return PARISH FAMILY AGREEMENT form to the school office with registration fee) (one form per family)
Parent/Guardian 2 Contributing to Christ the King Church *
Parent/Guardian 2 Envelope Number
Your answer
Parent/Guardian - Are you a CK Alumni? *
Parent/Guardian - If yes, year of Graduation?
Your answer
Parent (s) mailing name *
Your answer
Name student is called *
Your answer
Grade Entering *
Your answer
If registering for PreK4, have you previously attended a PreK4 class and utilized a VPK Voucher? *
Student's age as of September 1, 2016 *
Your answer
Previous School *
Your answer
Previous School Address *
Your answer
Student Date of Birth *
Your answer
Student Gender *
City of Birth *
Your answer
State of Birth *
Your answer
Country of Birth *
Your answer
Student's Race *
Student Ethnicity *
Student lives with *
If Other, please specify
Your answer
Does the parent who resides with this student have sole or shared responsibility? *
Student's Right to Remain Permanently in the U.S. *
If Other, please specify
Your answer
Student's Home Address *
Your answer
Student's Home City *
Your answer
Student's Home State *
Your answer
Student's Home Zip Code *
Your answer
Email to be used for School Correspondences *
Your answer
Student's Home Phone *
Your answer
Will this student require extended care? *
Student's Religion *
If Catholic, has your child been baptized? If Non-Catholic, then N/A. *
If yes, date
Your answer
If Catholic, name of the church of Baptism. If Non-Catholic, then N/A
Your answer
If Catholic, has your child received First Communion? If Non-Catholic, then N/A *
If yes, date
Your answer
If Catholic, has your child received Confirmation?If Non-Catholic, then N/A . *
If yes, date
Your answer
Student Allergies *
If yes, list allergies
Your answer
Does your child have learning difficulties or physical disabilities which would limit him or her from participating in the full life of the school? *
If yes, please explain
Your answer
Has your child had educational or psychological testing?If yes, please submit a copy of test results to the school. *
Is student currently taking medication on a regular basis? *
If yes, please specify:
Diagnosis/Condition
Your answer
Medication
Your answer
Dosages
Your answer
Frequency
Your answer
Name and Phone # of person other than parent to contact in case of emergency. *
Your answer
Name and Phone # of person 2 other than parent to contact in case of emergency. *
Your answer
Physician Name *
Your answer
Physician Phone Number *
Your answer
Dentist Name *
Your answer
Dentist Phone Number *
Your answer
Name of Hospital to take student in case of an emergency *
Your answer
Financial Responsibility: I assume the total responsibility of tuition and fees for the school year and understand that all tuition and fees paid are non-refundable. I agree to pay tuition according to the published schedule for the school year. Payments must be made on time in order to avoid late fees. *
I/We agree to read the 2016-2017 Student Handbook and agree to be governed by its contents. (Parent and Student) *
Without compensation, I hereby grant permission to the Catholic Diocese of Saint Augustine to use and reproduce photographs and/or video taken of my child. These photographs may be used for news and editorial purposes in publications and other electronic reproductions (websites and video) and/or brochures. In addition, I grant my permission to alter the same photos without restriction and to copyright the same. I hereby release the photographer, the journalists and the publications or media outlets they represent, as well as, the parish/church and/or school involved, the Bishop of the Diocese of St. Augustine, a corporation sole, the Catholic Diocese of Saint Augustine and all of their employees and agents, from all claims and liability relating to said photographs. ( Revised 5/1/2011) *
I understand that any action inconsistent with this Volunteer Code of Conduct may result in my removal as a volunteer with Christ the King School. The Diocese of St. Augustine requires that all volunteers must be fingerprinted, have background clearance, and have taken the Protecting God's Children Program. There are no exceptions. *
I hereby certify that all of the facts and information on all pages of this application are true and complete. I understand that any false, inaccurate, or misleading information given on this application is sufficient cause for rejection of this application. I also understand and agree that such false, incomplete, or misleading information discovered at any time on any part of this application is grounds to terminate any contract between applicant and Christ the King Catholic School. *
I understand that signing this document constitutes a legal signature confirming that I acknowledge and agree to the Terms of of this agreement. Please type your complete name. Electronic Signature:
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