2019-20 St. Mary Registration Application
All new students applying for admission to St. Mary for the 2019-20 school year should complete the form below. New students will need to provide the additional paper documents and registration fee to complete the application. A list of those documents can be found by visiting www.smss.org/admissions/how_to_enroll.
Father/Guardian Information
Please indicate relationship to student(s)
First Name
Your answer
Last Name
Your answer
Street Address
Your answer
City, State, and Zip Code
Your answer
Email
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Employer
Your answer
Occupation
Your answer
Is father/guardian a St. Mary alumni?
If an alumni, what year did you graduate?
Your answer
Mother/Guardian Information
Please Indicate relationship to student(s):
First Name
Your answer
Last Name
Your answer
Street Address
Your answer
City, State, and Zip Code
Your answer
Email
Your answer
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Occupation
Your answer
Employer
Your answer
Is mother/guardian a St. Mary alumni?
If an alumni, what year did you graduate?
Your answer
School Registration
Please complete information on the new student(s) in your family who will be attending St. Mary School System.

If enrolling more than 3 children, please complete a second on-line registration form.
1. Student's First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Name student prefers to be called:
Your answer
Gender
Birthdate
MM
/
DD
/
YYYY
Grade Entering 2019-20 School Year (Preschool-12th grade)
Your answer
Public School According to Residence
Your answer
School Student Currently Attends (include city and state)
Your answer
Ethnicity
Race: (Please mark all that apply)
2. Student's First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Name student prefers to be called:
Your answer
Gender
Birthdate
MM
/
DD
/
YYYY
Grade Entering 2019-20 School Year (Preschool-12th grade)
Your answer
Public School According to Residence
Your answer
School Student Currently Attends (include city and state)
Your answer
Ethnicity
Race: (Please mark all that apply)
3. Student's First Name
Your answer
Middle Name
Your answer
Last Name
Your answer
Name student prefers to be called:
Your answer
Gender
Birthdate
MM
/
DD
/
YYYY
Grade Entering 2019-20 School Year (Preschool-12th grade)
Your answer
School Student Currently Attends (include city and state)
Your answer
Public School According to Residence
Your answer
Ethnicity
Race: (Please mark all that apply)
Household Information
Religious Affiliation
Your answer
If Catholic affiliation, please select one of the options below for which parish you are a member:
If attending a Catholic Parish not listed above, please specify:
Your answer
Divorced or Separated Parents
St. Mary MUST have a copy of the divorce decree verifying custody arrangements on file with the school office.
If Divorced or Separated, who is the custodial parent?
Your answer
May child(ren) be released to non-custodial parent?
Emergency Information
In case of an emergency *
Required
Below list three (3) adults and their daytime phone numbers, to whom the school is authorized to release your child(ren)
1. Adult Name (First and Last) *
Your answer
Phone Number *
Your answer
Relationship to Child(ren) *
Your answer
2. Adult Name (First and Last) *
Your answer
Phone Number *
Your answer
Relationship to Child(ren) *
Your answer
3. Adult Name (First and Last)
Your answer
Phone Number
Your answer
Relationship to Child(ren)
Your answer
Emergency Medical Information
Physician Name *
Your answer
Physician Phone Number *
Your answer
Dentist Name *
Your answer
Dentist Phone Number *
Your answer
Hospital of Choice *
Your answer
Please list any pertinent medication/treatments/allergies for each of your child(ren) below.
Your answer
Please mark your answer: *
I consent for St. Mary School System to use my child(ren)'s name(s) and photo(s) in news publications, on social media, or on marketing materials. *
Please read the policies below and mark the boxes to indicate that you have read and understand the policies: *
Required
By submitting this registration form, I hereby warrant to St. Mary School System and/or After School Program that I am entitled to legal custody and possession of my child(ren) and am authorized to complete this form. Additionally, I have read and understand this form. In consideration, I agree to hold harmless and indemnify the St. Mary School System and its employees against all injuries arising out of these arrangement.
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