Fall 2023 Grade 1-8 St. Stanislaus Kostka School Registration Form

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$75 Registration Fee will be added to your tuition payment account once your student is accepted.

E-mailadres *

Date of Application *

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Student's First Name *

Student's Middle Name *

Student's Last Name *

Student's Date of Birth *

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Student's City of Birth *

Student's Gender *

Male

Female

Verplicht

Home Address: Street Address *

Home Address: City *

Home Address: State *

Home Address: Zip Code *

Parent/Guardian's Name #1 *

Parent/Guardian #1 Occupation *

Parent/Guardian #1 Cell Phone *

Parent/Guardian #1 Email *

Parent/Guardian's Name #2 *

Parent/Guardian #2 Occupation *

Parent/Guardian #2 Cell Phone *

Parent/Guardian #2 Email *

Race/Ethnicity *

Child lives with: *

Religion *

Catholic

Non-Catholic

Baptized *

Yes

Parents are registered members of: (Name of Church & City/Town or N/A) *

We request that our child's name be submitted to our pastor for financial sponsorship. *

Yes

My child is insured by: (Name of Insurance Provider or N/A) *

Most recent school attended: (Name of School & City/Town) *

Registering for Grade: *

My child currently has: *

An IEP (Individualized Education Plan)

A 504 Accommodation Plan

A diagnosed Learning Disability

None of the Above

Other

Verplicht

Individual(s) responsible for payment of tuition: *

Een kopie van je antwoorden wordt gemaild naar het adres dat je hebt opgegeven.

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