PRS Registration Kit - St Mary Elementary School

WELCOME TO OUR FAMILY
Dear Parents,
Welcome to Saint Mary School on the Campus of Saint Mary! Our commitment is to put your child
first. Through Catholic teachings, Saint Mary School’s nurturing staff provides academic excellence
within an intimate setting that is individualized to promote faith, respect and self-discovery.
Saint Mary School has maintained a proud and respected tradition of academic excellence and solid
spiritual formation since our doors opened in 1953. Today the growth and vision of Saint Mary School
is stronger than ever and is considered a preeminent Catholic school in the region.
Ever mindful of the Great Commission of Jesus Christ to “go make disciples,” Saint Mary School fulfills
this mandate by educating and forming boys and girls to be a transforming presence in the Church
and the world. Saint Mary School offers a dynamic Catholic curriculum integrating faith and reason, in
an environment in which students, faculty, and staff seek ongoing personal conversion to Jesus Christ
who is the Way, the Truth, and the Life.
We are committed to making the blessing of a Saint Mary School education available, accessible and
affordable for all families. Children are a valued treasure and a true gift from God to our families and
the Church. Saint Mary School is here for them! It is our sincere hope that your child will enroll in
our school and receive the many benefits of a Saint Mary School education, one that is academically
challenging and passionately Catholic. Welcome to our family.
Sincerely in Christ,
Sincerely,
Father Jeff Kegley
Pastor, The Parish of Saint Mary
Director, Saint Mary School
Mr. C. Kroekel
Principal
Saint Mary School
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS 2014
THE LITTLE SAINTS PRESCHOOL REGISTRATION KIT
for children Ages 2-3 by October 1, 2014
WELCOME TO OUR FAMILY
Dear Parents,
Thank you for your interest in The Little Saints Program for Preschool at Saint Mary School. We are busy
planning for the new school year, and we look forward to sharing all of the fun and excitement of learning
with your child.
Please review the enclosed information and forms. To enroll in our program, simply complete the Registration
Form and submit the required documents and fees. Upon receipt of these, your child will be registered for
September and placed on a Class List.
The following is required at the time of Registration:
• completed Registration form
• a copy of Birth Certificate
• a copy of Baptismal Certificate
• a copy of parent/guardian driver’s license
• required fees
The following is required prior to the first day of school:
• health form: “Medical • New Student Admission Physical” pages 5-6 of this pdf,
completed by your child’s physician
• a copy of student’s Immunization Record
Please note: Students are required to have a current flu shot dated between Sept. 1 – Dec. 31, 2014.
Students will NOT be permitted to start school without the proper documentation.
You will receive a letter in August advising you of the first day of school as well as your tuition coupon book.
If I can be of any assistance, please don’t hesitate to contact me.
Sincerely,
Stacie DePonti
Little Saints-Preschool Director
(732) 671-9198
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
COURSE SELECTION FOR LITTLE SAINTS PROGRAM: PRESCHOOL
My child
will be attending Preschool in September.
My preference for the 2014-2015 school year is as follows (please indicate first and second choice below):
TEENY TINY TOTS Must be 2 years old by October 1, 2014 • Registration and Supply Fees of $50 are due at Course Selection
choice Monday Morning (to begin in January)
9:00 –11:30 am
Tuition $500/year*
TINY TOTS Must be 2-1/2 years old by October 1, 2014 • Registration and Supply Fees of $50 are due at Course Selection
choice Tuesday & Thursday Morning
9:00 –11:30 am
Tuition $2,150/year*
choice Wednesday & Friday Morning
9:00 –11:30 am
Tuition $2,150/year*
SUPER TOTS Must be 3 years old by October 1, 2014 • Registration and Supply Fees of $75 are due at Course Selection
choice 2 days/week: Tuesday & Thursday
9:00am –1:00 pm Tuition $2,650/year*
choice 3 days/week: Monday,Wednesday & Friday 9:00am –1:00 pm Tuition $3,250/year*
choice 5 days/week: Monday through Friday
9:00am –1:00 pm Tuition $4,850/year*
* Tuition will begin in August with Coupon Book
PLEASE NOTE: All classes will be held pending registration. Every effort will be made to provide each registrant’s first choice.
PLEASE NOTE: We reserve the right to withdraw an offered class due to lack of enrollment.
PLEASE NOTE: There will be no absentee credit or tuition refunds.
Questions? Please contact Little Saints Program Director, Stacie DePonti at (732) 671-9198 or via email: [email protected]
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
REGISTRATION FORM FOR LITTLE SAINTS PROGRAM: PRESCHOOL
To be completed by parent/guardian. Please print.
CHILD’S INFORMATION*
Date
Last Name
First
Nickname
Address
City
State
Zip
Date of Birth
Age Now: Years
Months
Sex
Family Phone
Family Email
PARENT/GUARDIAN INFORMATION
* Both
Will both parents receive correspondence from school?
* Other or Legal Guardian (if applicable)
* Yes * No †
Father’s Name
Place of Business
Child lives with:
Email
* Father
* Mother
Cell Phone
Business Phone
Home Address
Home Phone
City
State
Zip
Mother’s Name
(Maiden)
Place of Business
Email
Cell Phone
Business Phone
Home Address
Home Phone
City
State
Zip
FAMILY INFORMATION
Names of Brothers and/or Sisters
Age
Names of Other Persons Living with the Child
FEES (NON-REFUNDABLE)
School They Attend (If Any)
Relationship
Registration $25.00
*Saint Mary School admits students of any race, color, nationality and/or ethnic origin.
†Parental rights in cases of separation or divorce, please attach a copy of Court Order.
Continued –Please complete back of application}
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
REGISTRATION FORM FOR LITTLE SAINTS PROGRAM: PRESCHOOL Continued.
PERSONAL HISTORY
Has the child had any previous group or preschool experience?
* Yes * No
If so, where and when?
Is your child fully potty trained?
* Yes * No
If no, please be advised that students enrolled in the SUPER TOTS PROGRAM must be fully potty trained by September.
Students enrolled in the TINY TOTS and TEENY TINY TOTS programs do not have to be fully potty trained,
but must be working on it. Please note, students must be in underwear or pull-ups – NO DIAPERS!
HEALTH CONCERNS
Attending Physician
Does your child have any allergies?
Phone
* Yes * No
If yes, please specify:
Are there any medical problems of which we should be aware?
Please write any additional information, remarks or concerns below:
EMERGENCY CONTACTS
Please provide us the names and telephone numbers of two LOCAL people who will accept responsibility for your child in an
emergency or if your child becomes ill at school and we cannot reach you. (We try to locate the parents first.)
Emergency Contact
Relationship
Phone
Cell Phone
Emergency Contact
Relationship
Phone
Cell Phone
Questions? Please contact Little Saints Program Director, Stacie DePonti at (732) 671-9198 or via email: [email protected]
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
MEDICAL • NEW STUDENT ADMISSION PHYSICAL
This form MUST be completed by your physician and returned to the Health Office before the student can be admitted to class.
STUDENT INFORMATION
Date of Exam
Last Name
First
Date of Birth
Height
HISTORY
YEAR
Weight
HISTORY
YEAR
Sex
Vision
Hearing
Blood Pressure
HISTORY
YEAR
YEAR
HISTORY
Food Allergies
Drug Allergies
Asthma
Non-Food/Non-Drug Allergies
Diabetes
Lyme Disease
Juvenile Rheumatoid
Auto Immune Disorders
Influenza (Flu)
Mononucleosis
Hepatitis
Autism Spectrum Disorders
Arthritis
Chronic Otitis Media
ADD/ADHD
Hematological Disorders
Congenital Disorder
Heart Disease
Convulsive Disorder
Neuromuscular Disorders
Strep Infections
Other illnesses
Operations
Injuries
PHYSICAL EXAMINATION (Please note each item)
ears
teeth-mouth
heart
genito-urinary
nervous system
eyes
orthopedic
lymph nodes
nutrition
abdomen
structural
thyroid
posture
speech
lungs
nose
feet
throat
skin
general appearance
IMMUNIZATION RECORD (MUST have complete date – month/date/year)
vaccine type
1st dose
mo/day/yr
2nd dose
mo/day/yr
3rd dose
mo/day/yr
4th dose
mo/day/yr
5th dose
mo/day/yr
Lead Screening
test date
result
Diptheria, Tetanus, pertussis (DTaP) or any
combination (if Td or DT, indicate in box)
Tdap
Polio-inactivated polio vaccine (IPV)
if oral indicate (OPV) in corner box
Measles, Mumps, Rubella (MMR)
Document below angle antigen vaccine receipt
Haemophilus (HB) **
serology, or varicella disease history
Hepatitis B
Hepatitis B
Date
Titer
Varicella
Varicella
Date
Titer
Pneumoccal Conjugate**
Measles
Date
Titer
Meningococcal
Mumps
Date
Titer
Hepatitis A***
Rubella
Date
Titer
HPV (Human Papillomavirus)***
Other
* Provisional admission attached – Date Granted:
* Medical exemption
* Religious exemption attached
Continued –Please complete back of form}
SMS PRS 2014
NOTE: Students participating on Saint Mary School Sports Team(s) MUST be complete the New Jersey DOE physical form.
Recommendations or restrictions:
PHYSICIAN INFORMATION
Physician Name (please print)
Address
Physician Phone
City
Zip
I have examined this child and find him/her physically fit to participate in school activities.
Signature of Physician (please sign)
Date
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
LITTLE SAINTS
EXTENDED DAY INFORMATION
We have several options for the Little Saints Extended Day Programs. Programs are staffed by the teachers
and aides of The Little Saints Preschool.
BREAKFAST CLUB Children are welcome to join us before starting school at 8 am on on school days
(as per school calendar). (Please be advised that students will only be able to enter the building between
8 am and 9 am). Students should bring something from home to eat and drink for breakfast. Students will
also have an opportunity for free play before beginning their day in their classroom at 9 am.
FUN CLUB Children may stay from 1 pm to 2:45 pm on school days (as per school calendar). Students
should bring something from home to eat and/or drink for snack. The Fun Club Program will provide
supervised recreation, enrichment activities and arts 'n' crafts for the children.
Fees will be collected monthly for September through May, September's payment will cover days in June.
BREAKFAST CLUB RATES
FUN CLUB RATES
NO. OF DAYS
MONTHLY RATE
NO. OF DAYS
MONTHLY RATE
day to day
$11
day to day
$21
1 day
$38.50
1 day
$77
2 days
$52
2 days
$103
3 days
$60
3 days
$120
4 days
$72
4 days
$145
5 days
$85
5 days
$170
LITTLE SAINTS EXTENDED DAY PROGRAM REGISTRATION
Please provide the following information. Please circle desired program and days of participation.
BREAKFAST CLUB
Monday
Tuesday
Wednesday
Thursday
Friday
FUN CLUB
Monday
Tuesday
Wednesday
Thursday
Friday
The Saints AfterClub provides extended day until 6 pm, to register or for more information please contact
the Saints AfterClub Coordinator, Peggy Dolan at (732) 671-0129 x301.
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014
PHOTO RELEASE FORM
2014-2015
This will confirm that I give permission for the child/children of my family:
Family Name
to have his/her photograph appear on the school website and/or in the school brochure.
I understand that the photograph(s) will be used solely for the Saint Mary School
marketing material, and will not be utilized for any other purpose.
Parent/Guardian Name (please print)
Date
Parent/Guardian Signature
Date
IT’S A GREAT DAY TO BE A SAINT!
538 church street, middletown, new jersey 07748 (732) 671-0129 www.stmaryes.org
SMS PRS 2014

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