St. Gregory the Great School

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					                                    Registration Form for Enrollment
                                          St. Gregory the Great School
                                                   250 St. Gregory Court
                                              Williamsville, New York 14221
                                                       716-688-5323
Please print clearly.                                                                    FOR OFFICE USE ONLY:
                                                                                    Date of application: ___________
Name of child ________________________________________________                      Application for grade __________
               Last                 First                Initial                    for the school year 2012-2013
Date of Birth _______________________ Sex: Male ( ) Female ( )                         Birth certificate       _______
                                                                                       Baptismal Certificate _______
Religion _______________ Race/Ethnicity: ______________________                        Immunization record _______

Home phone number _____________ Place of Birth _________________                    New Family $150.00 (non-refundable)
                                                                                       Administrative Fee due @ Registration +
E-mail address _________________________________                                    Tuition Deposit $100.00/child (non-
                                                                                    refundable) Due @ screening in May 2011
Mailing Address ______________________________________________
               _______________________________________________                      Siblings Tuition Deposit of $100.00
                                                                                    per child (non-refundable) due @
I am an active member of ______________________________ Parish.                     Registration
Where did you hear about our school: ______________________
                                                                                    Total Amount received       _______
Legal Name of Public School District of Residence of Child ___________.
Actual School Child would attend if not St. Greg’s __________________.              Person accepting this form _______
If applying for Kindergarten:                             If transferring from another school:
Did child attend Nursery School? Yes No                   Name of School __________________________________
Name of Nursery School ____________________                     Address __________________________________
           Address _______________________                               __________________________________
                                                            Phone number ____________ Grade last attended ______
List all children & ages:
1) _______________________age ________                    3) __________________________age _______
2) _______________________age ________                    4) __________________________age _______

      Sacraments             Date                     Church                                City/town
   Baptism
   Reconciliation
   First Eucharist

                Parent information                                               Parent information
Father         ____________________________                      Mother __________________ (maiden) ___________
Religion       ____________________________                      Religion       ____________________________
Occupation     ____________________________                      Occupation     ____________________________
Place of employment ________________________                     Place of employment ________________________
Business phone ____________________________                      Business phone ____________________________
Cell phone     ____________________________                      Cell phone     ____________________________
Page           ____________________________                      Page           ____________________________
Home address ____________________________                        Home address ____________________________
                (if different from student)                                      (if different from student)   OVER
                                              All information is confidential.
MARITAL STATUS OF PARENTS
   Marital status of parents:     circle one: married         separated      divorced         single
   Does child live with both natural parents? ________ If not, which parent has legal custody?_________
                (A copy of legal documentation must be provided to the school before the child enters.)
   If there is a step-father or step-mother, give the full name: ____________________________________

FINANCIAL RESPONSIBILITY will be assumed by                     ______________________________________
                                   relation to the student:     _________________________________________

MAIL CORRESPONDENCE AND REPORTS to:                           _________________________________________
                                                              _________________________________________
                                                              _________________________________________
ALUMNI INFORMATION
Please indicate if either parent is an alumni of St. Gregory the Great School. Please include maiden name.
        Name ________________________________                  Class of __________
        Name ________________________________                  Class of __________
HEALTH INFORMATION
       Child's physician    ______________________________________                      Phone number ___________
       Address of physician ______________________________________
                            ______________________________________
Describe any illnesses, diseases or physical and/or learning disability which may have or may affect your child's
general health, school work, or participation in the school's athletic program: ____________________________
__________________________________________________________________________________________
Has your child received a psychological or psychiatric evaluation or treatment in or outside of school? _______
Is there any other information that will help us meet your child’s academic needs? ________________________
__________________________________________________________________________________________
EMERGENCY INFORMATION
   List two persons who will assume temporary care of your child if you cannot be reached.
   Name ________________________________                       Name ________________________________
   Address ______________________________                      Address ______________________________
   Phone number         _____________________                  Phone number          _____________________
   Relation to student _____________________                   Relation to student   _____________________

           In case of accident or serious illness, I request the school to contact me. If the school is unable
           to reach me, I hereby authorize the school to call the physician indicated above and to follow
           his instructions. If it is impossible to contact this physician, the school may make whatever
           arrangements seem necessary for the best care of my child.

   Remarks _________________________________________________________________________
   Signature of parent or guardian _____________________________________ Date _______________

               Failure to give complete information may result in termination of this registration.

				
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