2023-2024 Early Child Development Center New Student Registration

Student Information

Registration Type

Full dayHalf day

Name*

First NameMiddle NameLast Name

Suffix

(Jr., III, etc.)

Nickname (name student goes by)*

Student currently lives with (check all that apply)*

Address (if different from guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

Social Security Number*

Gender*

MaleFemale

Race/National Origin

Date of Birth*

Date

Place of Birth (city and state)*

Present Parish

Nickname (name student goes by)

Student currently lives with (check all that apply)

Address (if different from guardian)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security Number

Gender

MaleFemale

Race/National Origin

Date of Birth

Date

Place of Birth (city and state)

Religion

(Ex. Catholic)

Present Parish

Parent/Guardian Agreement

You will be charged a one-time, non-refundable registeration fee of $300. This is inclusive of all supply fees for the year. This fee will be added to your FACTS (tutition payments) account as soon as your account is created.

I certify that all responses given on this application are true and complete. I understand that the falsification and/or omission of fact may result in denial of admission or removal of student from St. Mary Catholic School.

Parent/Guardian Signature (sign using a mouse on a desktop computer or a stylus/finger on a tablet).*

Today's Date*

Date

This is a pre-registration form for 2023-2024 for planning purpose only. It is not a contract. Non Refundable Registration Fee is due to the school when form has been submitted.

St. Mary School Early Learning Development Center Registration