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2022-2023 Pupil Registration Form
2022-2023 Pupil Registration Form
Please provide the requested information to being your students' enrollment for the upcoming academic year.
32Questions
2022-2023 Pupil Registration Form
  • 1
    Enter the student's first and last names.
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  • 2
    Choose the student's anticipated grade level for the upcoming academic year.
    • K
    • 1
    • 2
    • 3
    • 4
    • 5
    • 6
    • 7
    • 8
    • 9
    • 10
    • 11
    • 12
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  • 3
    Enter the date registration fees were received for this enrollment.
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    Pick a Date
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  • 4
    Select payment method
    • Cash
    • Check
    • PayPal
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    Enter
  • 5
    Registration Fee
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  • 6
    Total Registration Fees Paid
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  • 7
    Enter alternate payment arrangement notes
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  • 8
    Enter the date medical forms were submitted for this enrollment.
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    Pick a Date
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  • 9
    Enter the date students submitted their homework policy and honor code forms, if applicable.
    -
    Pick a Date
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  • 10
    -
    Pick a Date
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    Enter
  • 11
    For NYS reporting purposes only
    • American Indian/Alaskan Native
    • Black or African American (not Hispanic)
    • Native Hawaiian/Other Pacific Islander
    • Asian
    • Hispanic or Latino
    • White (not Hispanic)
    • Multi-racial (not Hispanic)
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  • 12
    Please enter your students' primary residential address.
    Please Select
    • Please Select
    • NY
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
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  • 13
    Press
    Enter
  • 14
    Please provide your students' primary phone number.
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    Enter
  • 15
    Please provide a primary email address for correspondence related to your students.
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    Enter
  • 16
    Please provide the father's first and last names.
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    Enter
  • 17
    Press
    Enter
  • 18
    Please provide the father's current address.
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 19
    Please provide home, work, and cell numbers, and designate the best number to reach during the school day.
    • Home
    • Work
    • Cell
    Press
    Enter
  • 20
    Please provide the father's email address.
    Press
    Enter
  • 21
    Please provide the mother's first and last names.
    Press
    Enter
  • 22
    Press
    Enter
  • 23
    Please provide the mother's current address.
    Please Select
    • Please Select
    • United States
    • Afghanistan
    • Albania
    • Algeria
    • American Samoa
    • Andorra
    • Angola
    • Anguilla
    • Antigua and Barbuda
    • Argentina
    • Armenia
    • Aruba
    • Australia
    • Austria
    • Azerbaijan
    • The Bahamas
    • Bahrain
    • Bangladesh
    • Barbados
    • Belarus
    • Belgium
    • Belize
    • Benin
    • Bermuda
    • Bhutan
    • Bolivia
    • Bosnia and Herzegovina
    • Botswana
    • Brazil
    • Brunei
    • Bulgaria
    • Burkina Faso
    • Burundi
    • Cambodia
    • Cameroon
    • Canada
    • Cape Verde
    • Cayman Islands
    • Central African Republic
    • Chad
    • Chile
    • China
    • Christmas Island
    • Cocos (Keeling) Islands
    • Colombia
    • Comoros
    • Congo
    • Cook Islands
    • Costa Rica
    • Cote d'Ivoire
    • Croatia
    • Cuba
    • Curacao
    • Cyprus
    • Czech Republic
    • Democratic Republic of the Congo
    • Denmark
    • Djibouti
    • Dominica
    • Dominican Republic
    • Ecuador
    • Egypt
    • El Salvador
    • Equatorial Guinea
    • Eritrea
    • Estonia
    • Ethiopia
    • Falkland Islands
    • Faroe Islands
    • Fiji
    • Finland
    • France
    • French Polynesia
    • Gabon
    • The Gambia
    • Georgia
    • Germany
    • Ghana
    • Gibraltar
    • Greece
    • Greenland
    • Grenada
    • Guadeloupe
    • Guam
    • Guatemala
    • Guernsey
    • Guinea
    • Guinea-Bissau
    • Guyana
    • Haiti
    • Honduras
    • Hong Kong
    • Hungary
    • Iceland
    • India
    • Indonesia
    • Iran
    • Iraq
    • Ireland
    • Israel
    • Italy
    • Jamaica
    • Japan
    • Jersey
    • Jordan
    • Kazakhstan
    • Kenya
    • Kiribati
    • North Korea
    • South Korea
    • Kosovo
    • Kuwait
    • Kyrgyzstan
    • Laos
    • Latvia
    • Lebanon
    • Lesotho
    • Liberia
    • Libya
    • Liechtenstein
    • Lithuania
    • Luxembourg
    • Macau
    • Macedonia
    • Madagascar
    • Malawi
    • Malaysia
    • Maldives
    • Mali
    • Malta
    • Marshall Islands
    • Martinique
    • Mauritania
    • Mauritius
    • Mayotte
    • Mexico
    • Micronesia
    • Moldova
    • Monaco
    • Mongolia
    • Montenegro
    • Montserrat
    • Morocco
    • Mozambique
    • Myanmar
    • Nagorno-Karabakh
    • Namibia
    • Nauru
    • Nepal
    • Netherlands
    • Netherlands Antilles
    • New Caledonia
    • New Zealand
    • Nicaragua
    • Niger
    • Nigeria
    • Niue
    • Norfolk Island
    • Turkish Republic of Northern Cyprus
    • Northern Mariana
    • Norway
    • Oman
    • Pakistan
    • Palau
    • Palestine
    • Panama
    • Papua New Guinea
    • Paraguay
    • Peru
    • Philippines
    • Pitcairn Islands
    • Poland
    • Portugal
    • Puerto Rico
    • Qatar
    • Republic of the Congo
    • Romania
    • Russia
    • Rwanda
    • Saint Barthelemy
    • Saint Helena
    • Saint Kitts and Nevis
    • Saint Lucia
    • Saint Martin
    • Saint Pierre and Miquelon
    • Saint Vincent and the Grenadines
    • Samoa
    • San Marino
    • Sao Tome and Principe
    • Saudi Arabia
    • Senegal
    • Serbia
    • Seychelles
    • Sierra Leone
    • Singapore
    • Slovakia
    • Slovenia
    • Solomon Islands
    • Somalia
    • Somaliland
    • South Africa
    • South Ossetia
    • South Sudan
    • Spain
    • Sri Lanka
    • Sudan
    • Suriname
    • Svalbard
    • eSwatini
    • Sweden
    • Switzerland
    • Syria
    • Taiwan
    • Tajikistan
    • Tanzania
    • Thailand
    • Timor-Leste
    • Togo
    • Tokelau
    • Tonga
    • Transnistria Pridnestrovie
    • Trinidad and Tobago
    • Tristan da Cunha
    • Tunisia
    • Turkey
    • Turkmenistan
    • Turks and Caicos Islands
    • Tuvalu
    • Uganda
    • Ukraine
    • United Arab Emirates
    • United Kingdom
    • Uruguay
    • Uzbekistan
    • Vanuatu
    • Vatican City
    • Venezuela
    • Vietnam
    • British Virgin Islands
    • Isle of Man
    • US Virgin Islands
    • Wallis and Futuna
    • Western Sahara
    • Yemen
    • Zambia
    • Zimbabwe
    • Other
    Press
    Enter
  • 24
    Please provide home, work, and cell numbers, and designate the best number to reach during the school day.
    • Home
    • Work
    • Cell
    Press
    Enter
  • 25
    Please provide the mother's email address.
    Press
    Enter
  • 26
    Press
    Enter
  • 27
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  • 28
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  • 29

    Health Records Requirements for New Entrants:

    Upon enrollment parents must submit the medical records from their physician which include:

    • General physical records
    • Immunizations
    • Disease history
    • Medications child takes regularly, time taken and purpose for use
    • Precautions staff should be aware of
    • Allergies child is shown to have
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  • 30
    Please note: The school board approved an increase on the Fixed Cost Tuition.  This new tuition still leaves us significantly below the median for the west side of Rochester, especially as you take advantage of the reimbursement available through your fundraising efforts.  Each family has the option to choose their level on fundraising involvement. (Ask about our 15% pastoral discount for ordained ministers currently serving in the ministry and our military/law enforcement discount for active military and law enforcement families.)
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  • 31

    Advance Payment Tuition Discounts

    Families making full payment in advance receive discounts according to the following schedule:

    On or before March 10, 2022 Tuition (column A only) discounted 3% 
    Between March 11 - April 10, 2022  Tuition (column A only) discounted 2%
    Between April 11 - May 10, 2022 Tuition (column A only) discounted 1%
    Between May 11 - August 1, 2022 No tuition discount will be offered

    All registrations completed after August 1, will be required to pay the registration fee and the first month’s tuition at the time of enrollment.

    Monthly Payment Option

    Families may also opt to make monthly payments through FACTS Tuition Management Services.  Each month the family would be billed for 1/10th of the total tuition and fees listed in column D of the tuition schedule.  For more information, visit the FACTS web site.

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  • 32
    The tuition rates above are in addition to the non-refundable registration fee of $300 for the first child, and $100 per child for any additional children. The fee is due at the time of registration.  A registration is not considered complete until the registration fee is submitted.
    • Our family will make advance payment in full.
    • Our family will make monthly payments via FACTS Tuition Management Services.
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  • 33

    Fundraising Policy

    Along with the fixed tuition, families also pay the reimbursable *fundraising fee listed in column B of the preceding tuition schedule.  Many of our families recover at least a portion of their fundraising fee.

    Each family pays the applicable fundraising fee throughout the year as part of the tuition.  Families participating in the various fundraisers receive a percentage of their fundraising efforts toward the fee (e.g., 50% of candy bar gross sales).  Provided a family’s tuition is paid in full, including the fundraising fee, the family’s share of their fundraising efforts, up to the amount of the fee, will be offered to the family as a reimbursement of the fundraising fee.  It also can be donated, as a whole or in part, back to the school.  Any fundraising credits exceeding a family’s fundraising fee will go entirely to the school.

    Credits to future years’ tuition, refunds, and donations are processed at the end of each school year.

    Example 1:

    The Doe family paid $1,700 for their family’s fundraising fee.  They sold $1,000 worth of candy bars, and they were credited 40% of their sales toward their fundraising fee ($400).  They also raised $5,000 in golf-a-thon sponsorships, which were credited at 80% toward their fundraising fee ($4,000).  Because their tuition was paid in full, including the fundraising fee, they were eligible to receive a $1,700 reimbursement.  The fundraising credits in excess of their fee directly benefitted the school, which helps to keep tuition low for all students.

    Example 2:

    The Jones family paid $1,700 for their family’s fundraising fee as well.  They sold $100 worth of candy bars, and they were credited 40% of their sales toward their fundraising fee ($40).  They also raised $1,500 in golf-a-thon sponsorships, which were credited at 80% toward their fundraising fee ($1,200).  Because their tuition was paid in full, including the fundraising fee, they were eligible to receive a $1,240 reimbursement.

    Annual Statements

    At the end of the year each family will receive a statement of how much they raised toward their target net profit, ($1100 for one student, $1700 for two students, etc.).  At that time each family decides between the following three options:

      • 1. Receive the reimbursement in full.
      • 2. Donate part, or all, of the reimbursable amount to the school.
      • 3. Apply part, or all, of the money to their unpaid tuition balance, including future years’ tuition.

    Your fundraising efforts directly benefit your own family’s overall enrollment costs, however all families have the option not to participate in each fundraiser.

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  • 34
    Please choose the applicable option.
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  • 35
    Please review and confirm your understanding of each of the following policies by checking each of the boxes.
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  • 36
    Use your finger on your touch screen to e-sign this document. Leave this blank empty and click NEXT to use your keyboard to type your signature.
    Clear
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  • 37
    Use your keyboard to enter your electronic signature
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  • 38
    Registration fees are $300 for the first student and $100 for each additional student. Please note your registration is not complete without payment of the appropriate non-refundable registration fees.
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  • 39
    Please select the appropriate total for registering your student(s): $300 for the first student + $100 for each additional student + 3% service fees
    prevnext( X )
    USD
    + OR enter a custom value
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