Clone of School Registration Form 26-27

St. Susanna Parish School

500 Reading Road, Mason, OH 45040
2027-2028 School Registration

Our registration period will begin on Sunday, October 25th and run through Friday, November 20th. Acceptances will be sent out in mid-December. After November 20th, enrollment may still be available based on class openings.

Additional documents are required for registration to be complete. Please bring the following documents to the school office or you can upload at the bottom of this form.
- Birth Certificate
- Baptismal Certificate (if Catholic)
- Current Immunization Records
- Custody documents (if applicable)
- Release of records (when registering for grades 1-8 only or repeating kindergarten)
- Registration fee ($100/one child or $150/two+ children). Payment can be made via cash, check (made out to St. Susanna School) or Online Giving.
**Registration will not be considered complete until the registration form and fee has been completed at a minimum**
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
This form will be available on Sunday, October 25th when our priority registration period opens.

Thank you!
Student Information
Legal Name:

First NameMiddle NameLast Name
Preferred name or nickname:
Date of Birth:

MonthDayYear
Gender:
Current Grade:
Expected Grade for Enrollment:
Ethnicity:
What language does your child speak most frequently?
What language do you speak most frequently to your child?
Religion:
If Catholic, which Parish are you currently registered?

Family Information
Family Primary Phone Number:
Please enter a valid phone number.Format: (000) 000-0000.
Family Primary Email Address:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Status of Parents:
Are you the natural parents of the child?
Are you the adoptive parents of the child?
If mother and father are separated/divorced, who has legal custody of the child?
Parent/Guardian

Please add both mother and father (or guardian) information below unless not applicable.
Relationship to Student:
Name:

First NameLast Name
Address (if different than student):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Home Email Address:
example@example.com
Work Email Address:
example@example.com
Religion:
Occupation:
Employer:
Parent/Guardian
Relationship to Student:
Name:

First NameLast Name
Address (if different than student):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number:

Area CodePhone Number
Work Phone Number:

Area CodePhone Number
Home Email Address:
example@example.com
Work Email Address:
example@example.com
Religion:
Occupation:
Employer:

Notes
Please list siblings and expected entry year at St. Susanna:
Please list the ministries at St. Susanna Parish in which you have been active during the past year or any other pertinent information regarding your registration. Thank you.
Please list any other pertinent information regarding your registration:
Birth Certificate

Cancelof
Baptismal Certificate

Cancelof
Immunization Records

Cancelof
Release of Records

Cancelof
Custody Documents

Cancelof
I, the undersigned, do hereby state and declare under penalty of falsification that I am the parent or legal guardian of the above named student and that this registration information is true and correct.
Electronic Signature of Parent/Guardian completing form:
Full Name
St. Susanna Parish School admits students of any race, color, and national or ethnic origin. This school complies with The Decree on Child Protection which is promulgated by the Archbishop of Cincinnati. Our fingerprinting policy includes manual fingerprinting for employees and electronic background checks for all employees and volunteers.

Certain information requested is mandated under Senate ORC Bill 140 and Education Management Information System (Sections 3301-0714).
Should be Empty:

St. Susanna Parish School

Student Information

School Information

Family Information

Parent/Guardian

Parent/Guardian

Notes