ATCHISON CATHOLIC ELEMENTARY SCHOOL REGISTRATION FORM 2008-2009

PRESCHOOL REGISTRATION FORM

STUDENT’S NAME_________________________________________________________________________

First Middle Last

BIRTHDATE__________________ SEX PLEASE CIRCLE- 3 YR or 4YR CLASS

PRESCHOOL SESSION PREFERENCE:

4 Year Old Preschool Only – MWF 8:00-11:00a.m. _MWF 12:30-3:30p.m.

LIST SIBLING(S)___________________________________________________________________________

CATHOLIC FAMILIES: Parish To Which You Contribute Financial Support ___________________

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Parent/Guardian_____________________________________________ Home Phone___________________

May We List Your Home Telephone Number In Our School Directory? YES NO

Address___________________________________________________________________________________

Father’s Full Name___________________________________________ Religion_______________________

Father’s Place Of Employment_____________ Work Phone

Mother’s Full Name__________________________________________ Religion________________________

Mother’s Place of Employment_________________________________Work Phone_____________________

Parent’s Marital Status______________ Mother’s Cell __________________Dad’s Cell__________________

Email Address______________________________________________________________________________

May We List Your Email Address In Our School Directory? YES NO

Racial Group Of Which Registered Student Is A Member (Optional)

____White ____African American ____Hispanic ____Native American ____Asian

IN CASE OF EMERGENCY: Please list the name and telephone number of your doctor and 3 other people we could contact in case you cannot be reached. (relative, babysitter, friend)

****For Safety Reasons - anyone NOT listed, as an emergency contact will not be allowed to pick up your child without parent permission.

Doctor_______________________________________________ Phone________________________

1. _________________________ Home Phone______________ Cell Phone ______________________

2. _________________________ Home Phone______________ Cell Phone ______________________

3. _________________________ Home Phone ______________Cell Phone ______________________

PLEASE LIST ANY HEALTH PROBLEMS/ALLERGIES YOUR CHILD MAY HAVE TO WHICH WE SHOULD BE ALERTED:

PLEASE DO NOT WRITE ON THIS SIDE OF THE REGISTRATION FORM

OFFICE USE ONLY

PRESCHOOL REGISTRATION FEE $65.00 _________

(Non-Refundable, due at registration)

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3-YEAR-OLD SESSION TUITION

Full year payment -- Due September 2, 2008 $600.00 _________

Two Semester Payments:

First Payment Due September 2, 2008 $315.00 _________

Second Payment Due January 6, 2009 $315.00 _________

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4-YEAR-OLD SESSION TUITION

Full year payment –Due September 3, 2008 $700.00 _________

Two Semester Payments:

First Payment Due September 3, 2008 $365.00 _________

Second Payment Due January 7, 2009 $365.00 _________

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RECORDS ON FILE:

________Birth Certificate

________Baptismal Certificate (Catholic Students)

________Immunizations Records