St Augustine's Classical Homeschool Program Registration Form
Thank you for registering your child for the Fall 2016-17 Academic Year! A non-refundable fee of $350.00 (all of which is applicable towards the spring tuition) will be required to complete the registration process. A child's placement in the Program will not be reserved without this fee. Please send payment to St. Augustine's HEP to the following address asap: 15776 W Poe Road, Bowling Green, Ohio 43402. If you have any questions or concerns, please contact us at 419-442-7958. Thank you.
Family Last Name
Please list your family's last name.
Your answer
First Name of Parent(s)
Please list the first name of the mother and father of the family.
Your answer
Address
Please submit your street name and number.
Your answer
City
Your answer
State
Your answer
Postal Code
Please enter your zip code.
Your answer
Home Phone Number
Your answer
Mom's Cell Phone Number
Your answer
Dad's Cell Phone Number
Your answer
Emergency Contact Name
Please give the name of the person to whom we should call in the case of emergency.
Your answer
Emergency Contact Phone Number
Your answer
Email Address
Your answer
List the names of any child(ren) you intend to have in the Nursery and his/her birth date(s).
Your answer
List the names of your prospective Pre-K (ages 3-5) student(s), if any, and his/her birth date(s).
Your answer
List the names of your prospective Primary School I student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Primary School II student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Lower School I student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Lower School II student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Middle School I student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Middle School II student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Upper School I student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Upper School II student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
List the names of your prospective Upper School III student(s), if any, and his/her birth date(s).
(For example: John Smith, age 9)
Your answer
Please list any allergies of your prospective student(s) to either food or medicine.
(For example: John is allergic to penicillin and acetaminophen. Or, John has no known allergies.)
Your answer
Please give instructions for any medical care.
(For example: Please do not administer any vaccinations without our parental permission. Or, John has persistent headaches and can be administered one aspirin when requested, etc....)
Your answer
Will you need a payment plan to pay for your child(ren)'s tuition?
Your answer
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