CTK Registration Form
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Last Name *
Your answer
Grade Entering *
Your answer
If registering for PreK4, have you previously attended a PreK4 class and utilized a VPK Voucher? *
Student Date of Birth *
Your answer
Student Gender *
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Parent/Guardian Relationship *
Parent/Guardian Salutation *
Parent/Guardian First Name *
Your answer
Parent/Guardian Middle Name
Your answer
Parent / Guardian Last Name *
Your answer
Parent/Guardian Suffix
Your answer
Gender *
Cell Phone *
Your answer
Email #1 *
Your answer
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Middle Name
Your answer
Parent / Guardian 2 Last Name
Your answer
Parent/Guardian Suffix
Your answer
Gender
Cell Phone
Your answer
Email #1
Your answer
Student Citizenship *
Student Birth City *
Your answer
Student Birth State *
Your answer
Student Birth Country *
Your answer
Student's First Language *
Your answer
Student's Race *
Student Ethnicity *
Student Religious Denomination *
Your answer
Congregation - If Catholic, Church you Attend. If Non-Catholic, then N/A *
Your answer
If Catholic, has your child been baptized? If Non-Catholic, then N/A. *
If yes, date, location, city and state
Your answer
If Catholic, has your child received First Communion? If Non-Catholic, then N/A. *
If yes, date, location, city and state
Your answer
If Catholic, has your child received Confirmation?If Non-Catholic, then N/A . *
If yes, date, location, city and state
Your answer
How do you intend to pay your tuition? (Please read all options and choose one) *
If using FACTS, how many payments do you plan to make?
Is either Parent or Guardian 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)
If so, Parent/Guardian Envelope Number
Your answer
Parent/Guardian - If Catholic, Church you Attend? If Non-Catholic, then N/A *
Your answer
Will this student require extended care? *
Please select the option for the Family Participation Plan *
Parent / Guardian Business Name
Your answer
Parent / Guardian Business Phone
Your answer
Parent / Guardian 2 Business Name
Your answer
Parent / Guardian 2 Business Phone
Your answer
Previous School
Your answer
Previous School Address
Your answer
Student lives with *
Name(s) of adult(s) who have legal custodial rights to this child. *
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? (All learning disabilities or difficulties MUST be disclosed in order to complete the registration process.) *
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. *
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 the 2018-2019 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:
Your answer
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