Enrollment Form for St. Jerome Atrium, 2018-2019
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 2018-2019 Atrium. Immunization forms are needed for enrolling in the 1:30-3:30 pm, Wednesday Atrium. If you are enrolling a second child, please fill out the form a second time -- one form per child.
Email address *
Child's First Name *
Your answer
Child's Last Name *
Your answer
Child's Birthdate *
MM
/
DD
/
YYYY
Atrium Level *
Level One is for children ages 3-6 years; Level Two is for children ages 6-9. Six-year-olds who are not independent readers should apply for Level One.
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.
Required
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 *
Your answer
Parent's Last Name *
Your answer
Primary Phone *
Your answer
Emergency Contact *
Please provide the name and phone number of at least one emergency contact other than the parent listed above.
Your answer
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.
Your answer
Special Needs
Please provide information about any special learning or medical needs your child might have.
Your answer
Medical Instructions *
Please check all that apply.
Required
Class Section *
Note: The Saturday Level One Session is now full. Thank you!
Note: Due to the requirements of the Archdiocese of Washington for St. Jerome Academy during school day hours, in order to enroll your child in the Wednesday 1:30 to 3:30 p.m. Level I Atrium, it is necessary to complete pages 1-2 of the Archdiocese of Washington Immunization Form here: http://www.stjeromes.org/sites/stjeromes.lifeaftersunday.net/files/Archdiocese%20of%20WashImmunization%202010-11.pdf (Submit this Form with initial deposit.)
Volunteering
The Atrium aide receives free tuition for his or her child.
Comments
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of St. Jerome Academy. Report Abuse - Terms of Service - Additional Terms