REGISTRATION School Year Registration PS-8 Grade. Family /Guardian Last Name. Father/Guardian Name Mother/Guardian Name

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1 REGISTRATION School Year Registration PS-8 Grade Family /Guardian Last Name Father/Guardian Name Mother/Guardian Name Street Address City State Zip Country Home Phone Cell (mother/guardian) Cell(father/guardian) Work (mother/guardian) Work(father/guardian) (mother/guardian) (father/guardian) Primary Language spoken at home Second Language Local School District of Residence Local Public School name and town location Mother/Guardian Occupation Job Title Employer Address City, State, Zip Father/Guardian Occupation Job Title Employer Address City, State, Zip Please complete this section for all children, Preschool -8 th grade who will attend for the school year. Child s Full Name Birthdate Gender (M/F) Grade Birth City, State, County Family Status total number of children # older than 8 th grade # younger than PS If child is not living with both parents, who has legal custody? Religious Information Religious Affiliation Church/Congregation City State Zip Phone Number Senior Pastor Local Church or Parish Member?

2 Catholic Sacrament Information Child s Name Baptism Church and Date Reconciliation Church and Date Communion Church and Date Emergency Contacts 1) Last Name First Name Salutation (Mr./Mrs./Ms.) Gender (M/F) Relationship Marital Status Street Address City State Zip Phone cell phone 2) Last Name First Name Salutation (Mr./Mrs./Ms.) Gender (M/F) Relationship Marital Status Street Address City State Zip Phone cell phone I authorize school personnel and medical authorities to give medical treatment as necessary to my child. Allergies: Conditions & RX: PARENT/GUARDIAN SIGNATURE: DATE: Doctor Name, Address and Phone Insurance Company Name, Policy #, Group # Dentist Name, Address and Phone IN AN EMERGENCY, THE SCHOOL OFFICE WILL CONTACT THE MOTHER / FATHER OR GUARDIAN AND TAKE THE STUDENT TO THE CLOSEST POSSIBLE EMERGENCY LOCATION. PLEASE SIGN BELOW TO AUTHORIZE SUCH ACTION. PLEASE WRITE ANY NOTATIONS BELOW IF NECESSARY. PARENT/GUARDIAN PARENT SIGNATURE: DATE: updated 1/4/16 cm

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7 St. Paul the Apostle Catholic School Payment Options Annual Trimester 10 Month Tuition Rate Rate 1 CHILD $ 4,125 $ 1,375 $ CHILDREN $ 6,400 $ 2,133 $ CHILDREN or more $ 7,700 $ 2,567 $ DAY all day Preschool(PS) $ 4,540 $ 1,513 $ DAY half-day PS (am only) $ 3,040 $ 1,013 $ DAY half-day PS (am only) $ 2,240 $ 747 $ Please Print: Family Fundraising Obligations: *$500 Raffle ticket sales (grades K-8) *Purchase two Dinner Dance/Auction tickets (PS-8 grades)$ (75 per ticket) Due at Reg. Day *Participation in School Annual Fund (Minimum of $25.00 donation) *Home & School membership dues per family 1 child $30 2 children $35 total 3 or more children $40 total Family/Guardian s Last Name:_ Father/Gurardian s Name:_ Home Phone: Address:_ City: Zip: Cell Phone:_ Mother/Guardian s Name:_ Home Phone:_ Address: City:_ Zip: Cell Phone:_ Parents/Guardian Financial Responsibility: Father/Guardian% Mother/Guardian% (Must total 100%) All Children Enrolled: (All Students Names and grades) Anticipated Tuition for : K-8 annual tuition $ Preschool annual tuition Raffle $500(K-8) Total annual obligation (excludes any potential financial assistance) $ Payment Options: When our tuition rate is computed for the school year, we would like to choose: Raffle (K-8) Tuition _1) $500 payment in August 1) Full Payment in before August 15 th with $60.00 discount _2) $500 over 10 monthsaug-may 2) 3 Payments In Trimesters: 8/1, 11/1, 2/1 3) Monthly payments divided over 10 months: (Aug--May) Paid by Cash, Check/Money Order * ACH Debit Form (enclosed) for 10 month option (3) above I agree to the payment option selected and will make every possible effort to make payments in full and on time. In the event a student withdraws from St. Paul the Apostle Catholic School before the end of the academic year, pro-rated tuition may be refunded through November 1 st. After November 1 st, no tuition money will be refunded. Fees such as H&S, Raffle Tickets, Auction, Annual Fund, and PPP are not refundable in part or in full. Signature: Date: **Must include your ACH Debit form with this option** For Office Use Only: Deposit Received: $ Date Cash or Check # Initials

8 Direct Draw Authorization Form for Tuition for School Year With the 10 month tuition direct draw option, one tenth of your family s annual tuition is automatically deducted from your checking account on the 5 th of each month from September through May. Complete the following information and return it to the school office with your registration packet if you choose the 10 month with direct draw ACH tuition payment option. I authorize St. Paul s to collect $ on the fifth day of each month from September, 2016 through May, The August, 2016 payment will be made by cash, check, or money order with the $100 registration deposit deducted (if applicable). The Parish Business Manager will confirm the monthly amount via prior to the September draw. ***I have attached a void check to this form for that purpose.*** Please print: Your name: Student(s) Name(s): Daytime phone: E mail address: Bank Routing #: Account #: Signature: Date: St. Paul the Apostle Catholic School 130 Woodlawn Ave. Joliet, Illinois office fax Please note: you may choose to pay tuition over the same ten months by check, cash, or money order if you prefer. You are advised to check with your bank regarding possible monthly fees for the direct draw ACH service.

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10 St. Paul the Apostle Catholic School Family Directory Permission St. Paul s School Family Directory for the Parents of St. Paul the Apostle School will be updated for the school year. Directories will be distributed within the first few weeks of school. Yes, please include our Family name, address and phone number No, please Do Not List any of our family information in the directory Name, Address only, NO PHONE NUMBER Name, Phone only, NO ADDRESS Family Name: ( please print) Signature: Date: Parent Permission to Photograph or Videotape It is necessary that you fill out this form so that your child will be able to participate in videotaped activities or those in which photographs are taken. Yes, I hereby give my permission to ST. PAUL THE APOSTLE CATHOLIC SCHOOL /PARISH to use my child s photograph, likeness and /or voice in any way that would reasonably and properly portray the program at ST. PAUL THE APOSTLE CATHOLIC SCHOOL/PARISH and /or the education of the children. I understand that the videotape and /or photos will become the property of the school. I also release ST. PAUL THE APOSTLE CATHOLIC SCHOOL/PARISH from any damages in using my child s photograph, likeness and /or voice. I do further certify that I am of full legal capacity to execute the forgoing authorization and release. No, I do not give my permission for the use of my child s photograph, likeness and /or voice as described above. *Please note: If you select No as your option, it requires that we not release any and all photos of your student(s) **This includes our school yearbook. This is a ALL or NOTHING policy.** FAMILY NAME: (please print) CHILD S NAME: Grade Grade Grade Grade Date: (parent/guardian signature, required) MUST BE RETURNED WITH THE FINAL REGISTRATION PAPERS

11 TO BE COMPLETED BY PARENTS WHO ARE SEPARATED OR DIVORCED SCHOOL YEAR Because our school has assumed responsibility for the education of your child (ren), we also wish to act responsibly whenever and/or wherever information concerning student achievement, behavior or welfare is concerned. Your completing the following, if appropriate, would be appreciated. THE RIGHTS OF NON-CUSTODIAL PARENTS As a general rule, the law allows students and/or student records to be released to either parent or to both parents or to legal guardians. If the non-custodial parent cannot have access to information, a copy of the court order must be given to school. Please circle: separated or divorced Do you consent to the child (ren) s non-custodial parent being appraised of his/her (their) school behavior and/or academic standing should he/she so request? Yes No Do you consent to the child (ren) s being released to the non-custodial parent? Yes No Comments: Date Signature of Parent or Guardian

12 DIOCESE OF JOLIET CATHOLIC SCHOOL Acceptable Use Agreement The schools within the Diocese of Joliet believe that all students should have access to technology when they act in a responsible, efficient, courteous and legal manner. Internet access and other network services available to students and teachers offer a multitude of global resources. Our goal in providing these services is to enhance the educational development of all our students. Acceptable and ethical uses of technology are devoted to activities that support teaching and learning. The following is an agreement for the use of technology at: This agreement is an abbreviated version of the Diocese of Joliet Acceptable Use Agreement. Using the computer correctly and responsibly is very important. I will follow these rules: 1. I will use the computer carefully and listen to the directions of my teacher. 2. I will only work on the programs and web pages that my teachers tell me to use. 3. I will ask for help, if I don t know what to do or which key to press. 4. I will tell my teacher if I read or see something on the computer that makes me afraid or uncomfortable. 5. I will not use the computer to be hurtful to others. 6. I will not give any information about my family, other students or myself to anyone on the Internet. 7. I will print only when my teacher tells me to. 8. I will only open my file or my own folder in the documents or on the student server. 9. I understand that if I do not follow or break one of the rules above, I may not be able to use the computer. I will sign my name to show that I will follow these rules Student Name (Print) Grade Student Signature Date I have read this Acceptable Use Agreement and have discussed it with my child: Parent/Guardian Name (Print): Parent/Guardian Signature: Date: ATTENTION NEW STUDENTS/PARENTS: Each new student will need a user ID and a password with which to log onto the computers & Internet. User ID s will be the students first initial, & last name (ie: JSmith or JOSmith if there are two children with the same initials.) and a 6 digit password (ie: me1234). This password should remain confidential and only your child and his/her teacher will have access to it. The only way someone can access this password is if your child shares it with someone. Thank you. Name 6-digit password Please print updated for: 16/17 school year

13 St. Paul the Apostle Catholic School WALKERS PERMISSION FORM School Year If you will be allowing your child to walk home, or go with another child, please let us know. Fill out the form below so that we have a record of children that are permitted to walk. We need to be sure that the children are where they are supposed to be for security reasons. Thank you for your help. My child (ren) has/have permission to walk home from St. Paul the Apostle Catholic School. Family Name: please print Home Address: Parent signature required Phone: Fill in this section: Child s Name: Grade in Grade in Grade in Updated 1/4/2016 cm

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