Home Address:
______________________________________________________________________________________________
(If different from
Student) (City)
(State)
(Zip)
Home Phone: (If different from Student)
___________________________________
E-Mail
E-Mail
Cell
Phone Number: ________________________ Address: ________________________________________
preferred: Y or N
Mother’s Name:
__________________________________________________________________________________________
Home Address:
______________________________________________________________________________________________
(If different from
Student)
(City)
(State) (Zip)
Home Phone: (If different from Student)
___________________________________
E-Mail
E-Mail
Cell
Phone Number: ________________________ Address:
________________________________________ preferred: Y or N
Guardian’s Name:
________________________________________________________________________________________
Home Address:
______________________________________________________________________________________________
(If different from Student)
(City)
(State)
(Zip)
Home Phone: (If different from Student)
___________________________________
E-Mail
E-Mail
Cell
Phone Number: ________________________ Address:
________________________________________ preferred___Y or N
Emergency Contacts
Authorized to pick up student: List
at least three (other than ones previously listed)
1. Name:
____________________________________________Relationship to family:
_____________________________________
Home
Phone:___________________________Cell:
________________________Other:__________________________________
2. Name: ____________________________________________Relationship
to family: _____________________________________
Home
Phone:___________________________Cell: ________________________Other:
__________________________________
3. Name: ____________________________________________Relationship
to family: _____________________________________
Home
Phone:___________________________Cell:
________________________Other:__________________________________
Parents Name:
____________________________________________________________________________
Students
Name:
____________________________________________________________________Entering
Grade: _________
Address:
___________________________________________________________________________________________________
(City) (State) (Zip)
Please specify: Caucasian,
African-American, Asian, Hispanic,other
Child lives with: _____Both
Parents ____Mother ____Father ____Other (explain)________________________
Does your child have any
diagnosed, physical or academic learning disabilities, allergies, or special
medical needs? Yes____ No ____
Receiving Treatment Yes ____
No ____ Current medication:
_______________________________________________________
Please Specify:
diagnosis/treating physician’s name: _________________________________________________________________
__________________________________________________________________________________________
If Student is Catholic:
Which sacraments will your child receive this year?
__________________________________________________________________
Baptism:
____________________________________________________________________________________________________
(Date)
(Church)
(City)
(State)
Penance: ____________________________________________________________________________________________________
(Date)
(Church)
(City)
(State)
Communion:
________________________________________________________________________________________________
(Date) (Church)
(City)
(State)
Confirmation:
________________________________________________________________________________________________
(Date) (Church) (City) (State)
__________________________________________________________________________________________
In order to process your registration we must have the
following items on file or attached.
____ Copy of Baptism Certificate (if Catholic)
____ Copy of Birth Certificate
____ Copy of Social Security Card
____ An up to date shot record on the HRS form (blue
card) filled out by you doctor’s office.
Please note if you have a
student entering:
Kindergarten- must have 5th DTP/DTAP/DT/TD, 4th Polio, 2nd
MMR, Hepatitis series and Varicella
7th grade they must have
their TD Booster and Hepatitis Series before the start of school.
|
For office use only: School records requested _____ Records received _____
Amount Paid
_________________ Check # ______________ Account Name
_____________________________________________________________ |
Tuition Rates Payment Plans
Ages
3 & 4
|
Payment Options |
Tuition |
Annual Payment Due rate reflects a 4% discount |
10 Monthly Payments |
|
In-Parish |
$3,070.00 |
$2,948.00 |
$307.00 |
|
Non- Supporting |
$4,059.00 |
$3,898.00 |
$406.00 |
Kindergarten
thru 8th Grade
|
Payment Options |
Tuition |
Annual
Payment Due rate reflects a 4% discount |
10 Monthly Payments |
|
In-Parish |
|
|
|
|
1- Child |
$2,713.00 |
$2,605.00 |
$272.00 |
|
2- Children |
$4,287.00 |
$4,116.00 |
$429.00 |
|
3- Children |
$5,200.00 |
$4,992.00 |
$520.00 |
|
Non-Supporting |
|
|
|
|
1- Child |
$4,456.00 |
$4,278.00 |
$446.00 |
|
2- Children |
$5,920.00 |
$5,684.00 |
$592.00 |
|
3- Children |
$6,842.00 |
$6,569.00 |
685.00 |
There will be an additional
$1,200.00 per student in families with more than 3 children.
Extended Day Rates
|
Extended Dare Care |
Extended Rate |
Time |
|
|
Monthly |
Most economical rate for
students using extended day most everyday. |
|
1- Child |
$105.00 |
|
|
2 -Children |
$150.00 |
|
|
3-Children |
$210.00 |
|
|
each additional
child |
$50.00 |
|
|
|
Daily |
Includes
Early Dismissal Days For occasional use |
|
1- Child |
$11.00 |
|
|
2 -Children |
$18.00 |
|
|
3-Children |
$25.00 |
|
|
each additional child |
$7.00 |
|
|
Early
Morning Extended Care Only |
Morning Care Rate |
Time |
|
|
Monthly |
|
|
1- Child |
$30.00 |
|
|
2 -Children |
$50.00 |
|
|
3-Children |
$70.00 |
|
|
each additional child |
$20.00 |
|
|
|
Daily |
For occasional use |
|
1-Child |
$3.00 |
|
|
2 - Children |
$5.00 |
|
|
3-Children |
$7.00 |
|
|
each additional
child |
$2.00 |
|
|
Protective Care Only |
Protective Care Rate |
Time |
|
|
Monthly |
Any student not picked up by
|
|
1- Child |
$30.00 |
be checked into Extended
Day and billed |
|
2 -Children |
$50.00 |
the daily rate. |
|
3-Children |
$70.00 |
|
|
each additional child |
$20.00 |
|
Voluntary Pre-
Kindergarten (VPK)
Children who are residents of
In order to guarantee your child’s placement
in the class for the 2006-2007 school year, a deposit of $200 will be collected
at the time of the acceptance of your application. This is a non-refundable
deposit. This deposit will be credited to your account to be applied toward
lunches, extended day services, and physical education uniforms.
VPK students
are provided 3 instructional hours per school day when St. Matthew’s
Tuition: The VPK program of 3 instructional
hours is FREE for eligible children, regardless of family income. The
current state legislative allocation is a tuition rate of $2,503.50 per
student. Tuition paid by the state are contingent on attendance.
EC Extended day
fees are NOT covered by the VPK
program. There will be a charge for all students in the full-time program
based on the hours of
Families are requested to provide items on the supply list for
their child.
|
4 Year
Olds Only |
Stay and
Play |
Extended
Day |
|
Daily |
$12.00 |
|
|
Monthly |
$200.00 |
|
|
|
|
|
|
|
Stay for
the Day |
|
|
Daily |
$20.00 |
|
|
Monthly |
$300.00 |
|
AGREEMENT OF REGISTRATION
The acceptance of this
application is contingent upon the student satisfactorily completing the grade
in which he/she is presently enrolled and if a new student at St. Matthew’s
Each student returning or new is
under a 30 day probationary period beginning the first day he/she attends
classes at St. Matthew’s. During this 30
day probationary period, students whose behavior and actions do not match the
philosophy of the school may be dismissed from St. Matthew’s
All families are required to serve 25 hours of service as described on the tuition schedule. Failure to serve all or any of the 25 required hours will result in an assessment fee of $8.00 per hour. There are many ways to participate and we welcome your suggestions as to your involvement.
The registration fee is non-refundable and must be paid at the time of registration. Resource fees for each student are due June 1st and are also non-refundable. Tuition may be paid as
explained in the tuition schedule with all first payments due in July. All
accounts must be current by the first day of school in order for the
student/students to attend classes.
I (we) agree to cooperate fully with all rules and regulations of St. Matthew’s Catholic School outlined in the handbook, tuition schedule, registration form, official calendar, and other official notices this school year.
Date____/____/____ Mother’s
Signature___________________________________________________
Date____/____/____Father’s
Signature____________________________________________________
Date____/____/____Student’s Signature___________________________________________________
Conditional Release
During the course of the school year we will take videos and photographs of classes, activities and events. We will use pictures to publicize the school, to make the school community aware of the scope of activities and to share videos and clips with other schools. Students’ images may also appear in newspapers and on television. Students may be asked to participate in polls and surveys.
I acknowledge and agree to the conditional release as stated above: