2023-2024 South Hills Catholic Academy Registration Form

2023-2024 South Hills Catholic Academy Registration Form - Student # 1

Please Register Oldest Student First
The "Additional Student Registration Form" Must Be Completed For Each Additional Registrant. That Form May Be Found Here.
The following are required for Registration at South Hills Catholic Academy to be complete:
- Birth Certificate (with intial registration)
- Baptismal Certificate (if applicable, with initial registration)
- Immunization Record (with initial registration)
- Registration Form for Each Student
- Tuition and Family Share Agreement
- Catholic School Parents Memorandum of Understanding (included in this form)
- Records Release Form - New Students Only (found here)
- Publicity Authorization (included in this form)
- Non-Refundable Registration Fee of $100 per Family
Student Information
Student's Full Name*

First NameLast Name
Student's Address*

Street Address

CityState

Zip Code
Gender*
Ethnicity*

CaucasianAfrican AmericanHispanicMulti-RacialOther
Birth Date *

MonthDayYear
Age as of September 1*
Entering Grade*

4 Year Old Preschool (Half Day)4 Year Old Preschool (Full Day)K (WAITLIST ONLY)1234 (WAITLIST ONLY)567 (WAITLIST ONLY)8 (WAITLIST ONLY)
Primary Parent / Guardian (Primary Person Who Will Receive School Communications)*

First NameLast Name
Primary Parent / Guardian Email*
example@example.com
Primary Parent / Guardian Phone Number*
Please enter a valid phone number.
Primary Language Spoken By Student*
Student Transportation*

Car RiderBus RiderWalkerAfter School GAP
Student Religion*
If Catholic, Include Parish and Diocese Names*

Sacramental Information of Student

	Check if Received	Date Received	Church Name and Address
Baptism
Reconciliation
Holy Eucharist
Confirmation

Public School District of Residence (Taxes Paid To)*

Baldwin WhitehallBethel ParkBrentwoodChartiers ValleyCity of PittsburghKeystone OaksMt. LebanonPeters TownshipSouth ParkUpper St. ClairOther
Public School Building Student Would Otherwise Attend*
Current School (If Not Applicable Enter N/A or SHCA if Returning Student)*
Address of Current School

Street Address

CityState

Zip Code
Parent Information
Mother's Name
First and Last Name
Mother's Address

Street Address

CityState

Zip Code
Mother's Email Address
example@example.com
Mother's Cell Phone Number
Mother's Home Phone Number
Mother's Work Phone Number
Please enter a valid phone number.
Mother's Employer and Occupation
Mother's Religion
Mother's Parish Where Registered
Is Mother a Catholic School Alumni?

YesNo
Father's Name
First and Last Name
Father's Address

Street Address

CityState

Zip Code
Father's Email Address
example@example.com
Father's Cell Phone Number
Please enter a valid phone number.
Father's Home Phone Number
Please enter a valid phone number.
Father's Work Phone Number
Please enter a valid phone number.
Father's Employer and Occupation
Father's Religion
Father's Parish Where Registered
Is Father a Catholic School Alumni?

YesNo
Student Resides With*

Both ParentsFather OnlyMother OnlyJoint CustodyOther

Please List Siblings of Student in Order of Birth

	First Name	Last Name	Gender	Date of Birth
Sibling #1
Sibling #2
Sibling #3
Sibling #4

Legal Guardian Information*
*ONLY COMPLETE IF FATHER OR MOTHER IS NOT THE LEGAL GUARDIAN
Student's Legal Guardian Is:

GrandfatherGrandmotherUncleAuntBrotherSisterOther
Legal Guardian's Name

Last NameFirst Name
Legal Guardian's Email Address
example@example.com
Legal Guardian's Cell Phone Number
Please enter a valid phone number.
Emergency Contacts
MUST BE SOMEONE OTHER THAN PARENT / GUARDIAN

(May be a parent ONLY IF PARENT IS NOT LISTED ABOVE)
Emergency Contact 1
Emergency Contact #1 Name*
First and Last Name
Emergency Contact #1 Relationship to Child*

GrandfatherGrandmotherUncleAuntBrotherSisterNeighborFriendFatherMotherOther
Emergency Contact #1 Cell Phone Number*
Please enter a valid phone number.
Emergency Contact 2
Emergency Contact #2 Name*
First and Last Name
Emergency Contact #2 Relationship to Child*

GrandfatherGrandmotherUncleAuntBrotherSisterNeighborFriendFatherMotherOther
Emergency Contact #2 Cell Phone Number*
Please enter a valid phone number.
Physician and Medical Information
Preferred Physician Office*
Physician Office Phone Number*
Preferred Hospital
In Order To Provide The Best Education For Your Child, Please Answer The Following Questions:
Does Student Have Any Allergies Or Medical Conditions School Should Be Aware Of?*

YesNo
If Yes, Please Explain Below:
Does Student Take Any Medication?*

YesNo
If Yes, Please List Below:
Has Your Child Ever Had a Psychological Examination?*

YesNo
Has Your Child Ever Been Diagnosed with a Learning Disability by a Physician?*

YesNoAn Evaluation is in Progress
If Yes, What Is The Diagnosis?
Has Your Child Ever Received Any of the Following Services?*

NoProject DARTCounselingRemedial MathEmotional SupportRemedial ReadingGifted SupportSpeech /LanguageLearning SupportOther
Has Your Child Ever Had an IEP?*

YesNo
If Yes, Please Indicate the Disability and Submit a Copy of the IEP to the School Office.
Has Your Child Ever Repeated a Grade? (If Yes, Please Explain Which Grade and Why in the "Other" Section.)*

YesNoOther
Has Your Child Ever Received a Suspension from School? (If Yes, Please Explain in the "Other" Section.)*

YesNoOther
Has Your Child Ever Been Asked to Transfer? (If Yes, Please Explain in the "Other" Section.)*

YesNoOther
Been Expelled from School? (If Yes, Please Explain in the "Other" Section.)*

YesNoOther
Catholic School Memorandum of Understanding

South Hills Catholic Academy Registration Requires Completion of this Form (One per Family)
Please Read

As a parent/guardian of a student in a Catholic school, I understand, affirm, and support the following:
1. The primary purpose of a Catholic school education is to form students in the values of Jesus Christ and the teaching of the Catholic Church.
2. Catholic schools are distinctive religious education institutions operated as programs of the Catholic Church; they are not private schools but are administered and supported by the sponsoring parish(es), the diocese, or religious community.
3. Attending a Catholic school is a privilege, not a right.
4. While academic excellence and involvement in extracurricular activity (i.e., sports, clubs, etc.) are important, fidelity to the Catholic identity of the school is the fundamental priority.
5. The school and its administration have the responsibility to ensure that Catholic values and moral integrity permeate every facet of the school’s life and activity.
6. In all questions involving faith, morals, faith teaching, and Church law, the final determination rests with the diocesan bishop.

Please Complete*

	First Name	Last Name	Entering Grade
Student #1
Student #2
Student #3
Student #4

Please Check To Acknowledge Acceptance Of This Memorandum Of Understanding:*

As a parent/guardian desiring to enroll my child in a Catholic school, I accept this Catholic School Memorandum of Understanding. I pledge support for the Catholic identity and mission of this school and by enrolling my child I commit myself to uphold all the principles and policies that govern a Catholic school.
Publicity Authorization

South Hills Catholic Academy Registration Requires Completion of this Form (One per Family)
Permission is hereby granted to SOUTH HILLS CATHOLIC ACADEMY to use voice recordings, photographs, video, and quotations of the student(s) listed below to assist in its community awareness, educational efforts, and related public relations purposes through use of social media (including website).

SOUTH HILLS CATHOLIC ACADEMY agrees to not use last names of student(s) listed below to assist in its community awareness, educational efforts, and related public relations purposes through use of social media (including website).

Please Complete*

	First Name	Last Name	Entering Grade
Student #1
Student #2
Student #3
Student #4

Please Check One:*

Yes, images/videos may be used for SOUTH HILLS CATHOLIC ACADEMY publicity efforts.I do not wish images/videos to be used for SOUTH HILLS CATHOLIC ACADEMY publicity efforts.
Please Sign and Pay Registration Fee to Complete Form
Please Sign Here and Pay the Registration Fee Below:*

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Pay Here

IMPORTANT: Registration Fee must be paid before registration is complete. Please click "SUBMIT" after entering Credit or Debit Card information to complete the transaction. If "Thank You" page doesn't appear, the form has not been submitted and contains an error(s).
Please Pay Registration Fee of $100.00 per Family*

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Credit Card Number	Security Code
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2023-2024 South Hills Catholic Academy Registration Form - Student # 1

Student Information

Parent Information

Legal Guardian Information*

Emergency Contacts

Physician and Medical Information

In Order To Provide The Best Education For Your Child, Please Answer The Following Questions:

Catholic School Memorandum of Understanding

As a parent/guardian of a student in a Catholic school, I understand, affirm, and support the following:

Publicity Authorization

Please Sign and Pay Registration Fee to Complete Form

Pay Here