Returning Student(s)

Preschool & Junior Kindergarten Students

2025 - 2026 School Year
Student # 2 - Pre-K 4 DLI / Jr. Kdg. 4*

First Name Middle Name Last Name
Student # 2 - Program Choice*
Date of Birth:*

MonthDayYear
Date
Student # 2 - Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another Preschooler or Junior Kdg.Let me add a K - 8 studentTake me to Family Data Changes

Preschool & Junior Kindergarten Students

2025 - 2026 School Year
Student # 3 - Pre-K 4 DLI / Jr. Kdg. 4*

First Name Middle Name Last Name
Student # 3 - Program Choice*
Date of Birth:*

MonthDayYear
Date
Student # 3 - Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another PreschoolerLet me add a K - 8 studentTake me to Family Data Changes

Preschool & Junior Kindergarten Students

2025 - 2026 School Year
Student # 4 - Pre-K 4 DLI / Jr. Kdg. 4*

First Name Middle Name Last Name
Student # 4 - Program Choice*
Date of Birth:*

MonthDayYear
Date
Student # 4 - Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another Preschooler or Junior Kdg.Let me add a K - 8 studentTake me to Family Data Changes

Preschool & Junior Kindergarten Students

2025 - 2026 School Year
Student # 5 - Pre-K 4 DLI / Jr. Kdg. 4*

First Name Middle Name Last Name
Student # 5 - Program Choice*
Date of Birth:*

MonthDayYear
Date
Student # 5 - Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add a K - 8 studentTake me to Family Data Changes

Kdg. - 8 Students

2025 - 2026 School Year
K-8 Student # 1:*

First Name Middle Name Last Name
K-8 Student # 1 - Grade (2025-26)*
K-8 Student # 1 - Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another K - 8 studentTake me to Family Data Changes
Are the exam forms for Student 1 ready to be uploaded?*

YesNo
* No later than August 1, 2025, please bring a copy of your child's exam forms with immunizations to the school office or e-mail them to attendance@stcletusparish.com.
Kindergarten:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
3. Eye Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
2nd Grade:
1. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th Grade:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th, 7th & 8th Grade:
1. Students are required by the State of Illinois to have proof they have received a Tdap vaccine against Pertussis.
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
Files Upload

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K - 8 Students

2025 - 2026 School Year
K-8 Student # 2*

First Name Middle Name Last Name
K-8 Student # 2 - Grade (2025-26)*
Student # 2 Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another K - 8 studentTake me to Family Data Changes
Are the exam forms for Student # 2 ready to be uploaded?*

YesNo
* No later than August 1, 2025, please bring a copy of your child's exam forms with immunizations to the school office or e-mail them to attendance@stcletusparish.com.
Kindergarten:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
3. Eye Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
2nd Grade:
1. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th Grade:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th, 7th & 8th Grade:
1. Students are required by the State of Illinois to have proof they have received a Tdap vaccine against Pertussis.
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
Files Upload

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K - 8 Students

2025 - 2026 School Year
K- 8 Student # 3

First NameMiddle NameLast Name
Student # 3 Grade (2025-2026)*
Student # 3 Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another K - 8 studentTake me to Family Data Changes
Are the exam forms for Student 3 ready to be uploaded?*

YesNo
* No later than August 1, 2025, please bring a copy of your child's exam forms with immunizations to the school office or e-mail them to attendance@stcletusparish.com.
Kindergarten:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
3. Eye Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
2nd Grade:
1. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th Grade:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th, 7th & 8th Grade:
1. Students are required by the State of Illinois to have proof they have received a Tdap vaccine against Pertussis.
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
Files Upload

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K - 8 Students

2025 - 2026 School Year
K- 8 Student # 4

First NameMiddle NameLast Name
K-8 Student # 4 - Grade (2025-26)*
Student # 4 Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Since this student is not returning where would you like to go?*

Let me add another K - 8 studentTake me to Family Data Changes
Are the exam forms for Student 4 ready to be uploaded?*

YesNo
* No later than August 1, 2025, please bring a copy of your child's exam forms with immunizations to the school office or e-mail them to attendance@stcletusparish.com.
Kindergarten:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
3. Eye Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
2nd Grade:
1. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th Grade:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th, 7th & 8th Grade:
1. Students are required by the State of Illinois to have proof they have received a Tdap vaccine against Pertussis.
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
Files Upload

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K - 8 Students

2025 - 2026 School Year
K-8 Student # 5

First Name Middle Name Last Name
Student # 5 Grade (2025 -2026)*
Student # 5 Returning Status:*

ReturningNot Returning
Please specify reason for not returning:*
Are the exam forms for Student 5 ready to be uploaded?*

YesNo
* No later than August 1, 2025, please bring a copy of your child's exam forms with immunizations to the school office or e-mail them to attendance@stcletusparish.com.
Kindergarten:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
3. Eye Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
2nd Grade:
1. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th Grade:
1. Physical Exam - including the Lead Questionnaire and diabetes screening completed by the child’s healthcare provider and the Health History portion completed and signed by the parent/guardian. Proper documentation of the following immunization series: Tdap, Polio, MMR, Hib, HepB, Pneumococcal, and Varicella.
2. Dental Exam
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
6th, 7th & 8th Grade:
1. Students are required by the State of Illinois to have proof they have received a Tdap vaccine against Pertussis.
Note: Exam forms (physical, dental and eye) are available at your physicians' offices.
Files Upload

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Family Data Change(s): Enter updated data only.
Do you need to update your personal information, such as home address, phone number(s), e-mail(s), emergency contact(s)?*

YesNo
Name of Mother

First NameMaiden NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Mobile / Primary Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Martial Status: Select One
Email:
Please enter a valid email
Mother's Employer / Occupation:
Work Days / Hours:
Name of Father

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Father's Mobile / Primary Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Marital Status: Select One
Email:
Please enter a valid email
Father's Employer / Occupation:
Work Days / Hours:
Name of Legal Guardian

First NameLast Name
Guardian's Mobile / Primary Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status: Select One
Email:
Please enter a valid email
Guardian's Relationship to Student: Select One
Occupation:
Work Days / Hours:
Emergency Contacts and other adults authorized to pick up your children:

Extended Care Program - 2025-2026
Extended Care Program Information:

Click Here
Do you plan on using the extended care program?*

YesNo
Student Information*
Choose All That May Apply:

Before Care Regular UserBefore Care Occasional UserAfter Care Regular UserAfter Care Occasional User
Parent/Guardian Information
Mother Name

First NameLast Name
Mother Phone Number
Please enter a valid phone number.
Father Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contacts and other adults authorized to pick up your children.*
NOTE: We may request a photo ID of the authorized person picking up your child(ren).
Parent Authorization for Before Care / After Care program enrollment (please initial below)initials*

Tuition Assistance Program - 2025-2026
Families requesting tuition assistance for the 2025-2026 school year may apply for St. Cletus School assistance through FACTS Management's Tuition Grant & Aid Program.

FACTS Tuition Grant & Aid Program (St. Cletus School Tuition Assistance)

FACTS Grant & Aid Application
- FACTS charges a $30.00 application fee.
- Tuition assistance awards will be determined and assigned in spring 2025.
- If you plan to apply, please do not delay--tuition scholarships are partly determined by the number of families requesting assistance.
Planning to apply for tuition assistance for 2025-2026?*

YesNo

Acknowledgement, Authorization, and Consent
If your family is not returning, please sign at the bottom of this page and Submit. Thank you.
By signing this form, I hereby authorize the school to use the information herein provided for the processing of my child's application. I understand that the information shared herein shall be for the purpose of the admission of my child.

I authorize and provide consent to the school in releasing my child's medical and health information with the school's health services.

In the event that my child becomes ill, sustains an injury, or in any case, needs immediate medical care during under the care and supervision of the school, I hereby authorize the school to administer first aid for my child's relief.

In the event that my child needs immediate attention and it is not practical to wait for receiving instructions from the parents or appointed legal guardian or the child, I, as a parent/legal guardian, hereby authorize the school and its staff to call 911.

I further declare that the information I have provided in this form is true and correct to the best of my knowledge.
Signature of Parent/Guardian

Clear
Date*

MonthDayYear
Date
Should be Empty:

St. Cletus School Returning Students - 2025-2026

Returning Preschool 4 DLI & Junior Kdg. 4-Year-Old Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form, complete & sign; have

physician complete & sign; and submit the forms to the school office.

Preschool & Junior Kindergarten Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

Preschool & Junior Kindergarten Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

Preschool & Junior Kindergarten Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

Preschool & Junior Kindergarten Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

Kdg. - 8 Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

K - 8 Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

K - 8 Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

K - 8 Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

K - 8 Students

School Nurse Questionnaire (Required Annually) (One Form Per Student)

Medication Authorization

If medication is needed at school, please complete this required

School Medication Procedures Form; complete & sign; have

physician complete & sign; and submit the forms to the school office.

Family Data Change(s): Enter updated data only.

Extended Care Program - 2025-2026

Extended Care Program Information:

Tuition Assistance Program - 2025-2026

Acknowledgement, Authorization, and Consent