School registration form

SAINT JOSEPH SCHOOL

2010-2011 REGISTRATION

Child’s Last Name: ____________First Name______________Grade in fall _____

____________ ______________Grade in fall _____

Student/s’ Religion____________________________

Last Name of Father/Guardian _______________

First Name of Father/Guardian ______________

Address______________________________E-mail__________________________

City _______________ State____ Zip code______________

Home Phone_________________ Cell __________________

Work Phone_________________

Religion ____________________

If Practicing Catholic, Parish registered _________________

First Name of Mother/Guardian ______________________

Last Name of Mother/Guardian _______________________

Address__________________________ Email________________________________

City _______________ State____ Zip code______________

Home Phone _________________Cell ___________________

Work Phone_________________

Religion ____________________

If Practicing Catholic, Parish registered _____________Tithing: Yes____No___

Public School student would attend____________________________________

Ethnic background American Indian/Native______ Native Hawaiian/Pacific______

Asian______ White______

Black______ Multi-ethnic________

Hispanic_______

Registration Fee: $150 per student + $75 one time family fee

1 child =$225, 2 children = $375, 3 children = $525

Installments Paid: 1^st ________ (2/19/2010) 2^nd ___________ (3/19/2010)

Check # ________ Check # _________

Cash _________ Cash _________

$50 late fee after 3/19/10

If requesting Financial Assistance please check here: Yes____No____

______2010-2011 Contract date issued ___________ (office use only)