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Fall 2023 St. Stanislaus Kostka Preschool Registration Form
$75 Registration Fee will be added to your tuition payment account once your student is accepted.
Please note: All preschool offering are dependent on enrollment. All applicants must be potty-trained and at least 3 years old as of September 1st.
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* Indicates required question
Email
*
Your email
Date of Application
*
MM
/
DD
/
YYYY
Kindly select the program you wish for your child:
*
2 Half Days (Tues & Thurs 8:30-11am)
3 Half Days (Mon, Wed & Fri 8:30-11am)
5 Half Days (Mon-Fri 8:30-11am)
2 Full Days (Tues & Thurs 8:30am-3pm)
3 Full Days (Mon, Wed & Fri 8:30am-3pm)
5 Full Days (Mon-Fri 8:30am-3pm)
If there are specific days (outside of the options above) that you would like your child to attend, please specify here.
Your answer
Student's First Name
*
Your answer
Student's Middle Name
*
Your answer
Student's Last Name
*
Your answer
Student's Date of Birth
*
MM
/
DD
/
YYYY
Student's City of Birth
*
Your answer
Student's Gender
*
Male
Female
Required
Home Address: Street Address
*
Your answer
Home Address: City
*
Your answer
Home Address: State
*
Your answer
Home Address: Zip Code
*
Your answer
Parent/Guardian's Name #1
*
Your answer
Parent/Guardian #1 Occupation
*
Your answer
Parent/Guardian #1 Cell Phone
*
Your answer
Parent/Guardian #1 Email
*
Your answer
Parent/Guardian's Name #2
*
Your answer
Parent/Guardian #2 Occupation
*
Your answer
Parent/Guardian #2 Cell Phone
*
Your answer
Parent/Guardian #2 Email
*
Your answer
Race/Ethnicity
*
Choose
African American
Asian
Hispanic
Latino
Native American
White
Child lives with:
*
Choose
Both parents
Mother
Father
Other
Religion
*
Catholic
Non-Catholic
Baptized
*
Yes
No
Parents are registered members of: (Name of Church & City/Town or N/A)
*
Your answer
My child is insured by: (Name of Insurance Provider or N/A)
*
Your answer
Early Childhood Intervention Services:
*
Yes
No
Individual(s) responsible for payment of tuition:
*
Your answer
A copy of your responses will be emailed to the address you provided.
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