St. Mary's School 2019-2020 Enrollment
REGISTRATION IS NOT CONSIDERED COMPLETE UNTIL THE OFFICE RECEIVES $100 PER STUDENT FEE.
Email address *
Last Name of Student as appears on Birth Certificate *
Your answer
First Name of Student as appears on Birth Certificate *
Your answer
Middle Name of Student as appears on Birth Certificate *
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 2019-2020? *
Pre School 4 year Old Time Preference (Please note that your choice is only secured once we receive your Registration Fee and our Admissions Policy is completed) (Link to policy located on page 8: https://school.ccjc3.org/wp-content/uploads/2018/10/Family-Handbook-2018-2019.pdf )
Pre School 3 year Old Time Preference (Please note that your choice is only secured once we receive your Registration Fee and our Admissions Policy is completed) (Link to policy located on page 8: https://school.ccjc3.org/wp-content/uploads/2018/10/Family-Handbook-2018-2019.pdf )
Address of Student *
(please use correct format. For County Road, please use Co Rd Please do not use characters or periods. EX: 1234 S Co Rd 100 E)
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. Format: 000-000-0000
Your answer
Any known health concerns of Student *
If "No" health concerns please indicate with NA
Your answer
Guardian/Parent Information
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 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 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
Are you a new parent to St. Mary's School? *
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