St. Anne Catholic School
Extended Day Program
Registration Form
 

(Return to St. Anne Catholic Church)

There is a NON-REFUNDABLE  $10.00 registration fee per Family. A bill will be sent to you before the due date on the School Calendar.     (Calendar online)

The telephone in the gym cannot call a cell phone number.  Most of the time, an employee will have a cell phone that can make an emergency cell phone call, but not always.  Please make sure we can contact someone.

If someone, other than the authorized person, is going to pick up your child, please send a note or call and leave a message with Kathy in the school office.  We will not release your child unless we have permission from the parent.

Please fill out all of the information. Check to make sure all the information is correct then click the SUBMIT FORM Button at the bottom of the page.
 
Use the Mouse or Tab button to go from one selection to another.  If you use the ENTER or RETURN button it will Submit the page.
 

   Student's Name        Grade 

  Student's Name        Grade 

  Student's Name        Grade 

  Student's Name        Grade 

  Authorized persons to pick up child/children

  1.    2. 

  3.    4. 

  Parents' Name                 

  Home Address     

  City/State/Zip   

  Home Phone #  (Mom)           Home Phone #  (Dad)    

   Cell  Phone #    (Mom)             Cell  Phone #    (Dad)    

  Work  Phone #  (Mom)            Work Phone #  (Dad)    

  Emergency Contact (Name)     Phone #

  Hospital Preference   

  Family Physician    Phone# 

  Any Food or Medicine Allergies        If Yes describe below:

 

  In case of an emergency (injury/sick), which number should we call first?      

  In you are late or forgot to pick up your child, which number first?      

  Which child would you like the bills sent home with?      Grade 

When you submit this form you are indicating your support in this program and that you agree to make monthly payments of required fees and adhere to all rules and regulations.  Failure to meet the conditions of this agreement may result in your child being dismissed from the program.

Your Name          Date   


Copyright © 2005    All rights reserved.
Revised: 08/30/06