1. MOTHER DR. MRS. MS. FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL OCCUPATION TITLE EMPLOYER FATHER DR. MR. FIRST NAME LAST NAME MIDDLE NAME MALE FEMALE Pre-School 2016-2017 School Year Required for Pre-School Please submit form with application fee APPLICANT (STUDENT) INFORMATION DATE OF BIRTH (MM/DD/YYYY) GRADE LEVEL FOR 2016-17 FAMILY INFORMATION APPLICATION FOR REGISTRATION & ENROLLMENT AGREEMENT SAINT JOSEPH SCHOOL A Higher Standard All information must be completely filled-in before accepted NICKNAME (IF PREFERRED) FULL NAME HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL OCCUPATION TITLE EMPLOYER PARENTS ARE MARRIED AND LIVING TOGETHER PARENTS ARE SEPARATED MOTHER IS REMARRIED NAME OF STEPFATHER PARENTS ARE DIVORCED SINGLE PARENT FATHER IS REMARRIED NAME OF STEPMOTHER GUARDIAN (if applicable) FULL NAME RELATIONSHIP TO APPLICANT HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL RETURNING STUDENT NEW STUDENT WITH WHOM DOES THE STUDENT PRIMARILY RESIDE? (CHECK ALL THAT APPLY) MOTHER FATHERLEGAL GUARDIAN OTHER (PLEASE EXPLAIN ) HOME STREET CITY STATE ZIP RACE / ETHNICITY: AFRICAN AMERICAN/BLACK ASIAN AMERICAN CAUCASIAN/WHITE LATINO/HISPANIC MULTIRACIAL NATIVE AMERICAN PACIFIC ISLANDER OTHER RELIGION: CATHOLICNON-CATHOLIC WHAT PUBLIC SCHOOL BUILDING WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL (FOR EXAMPLE: COUNTRY DAY, POWERS, ETC.)? WHAT PUBLIC SCHOOL DISTRICT WOULD THE STUDENT ATTEND IF THEY WERE NOT ENROLLED AT SAINT JOSEPH SCHOOL? HOW DID YOU FIRST HEAR ABOUT SAINT JOSEPH SCHOOL AND WHAT LED TO YOUR DECISION TO CHOOSE SAINT JOSEPH SCHOOL AS THE PLACE OF EDUCATION FOR YOUR CHILDREN? REFFERAL: * *a copy of the divorce decree pertaining to the child must be on file in the school MARITAL STATUS: (CHECK ALL THAT APPLY) 4 YEAR OLD PRE-SCHOOL (THE CHILD MUST BE 4 YEARS OLD BY AUG. 1 ST 2016) 3 YEAR OLD PRE-SCHOOL (THE CHILD MUST BE 3 YEARS OLD BY AUG. 1 ST 2016)

2. FULL NAME RELATIONSHIP TO APPLICANT HOME STREET CITY STATE ZIP CELL PHONE WORK PHONE HOME PHONE EMAIL PARISHIONER STATUS 175 Saint Joseph Drive Amherst, OH 44001 [p] (440) 988-4244 [f] (440) 988-5249 www.sjsamherst.org SAINT JOSEPH SCHOOL A Higher Standard SCHOOL OFFICE TUITION Please select one: ACTIVE PARISHIONER OF SAINT JOSEPH PARISH Membership: Registration is the first step to becoming an active and participating parishioner of Saint Joseph Parish. Being active includes 1)Will participate at Mass every Sunday and holydays of obligation. We will give evidence of our being present by using our Sunday Offertory envelopes every week, whether full or empty. 2)Will participate in at least one ministry in our parish, whether within the school itself or within the Parish at large.3)Regularly contribute financially to the support of our Parish according to the way we have been blessed. If we are not already tithing, we will work towards this goal. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE NON PARISHIONER / NON-ACTIVE PARISHIONER ENVELOPE NUMBER As a non-parishioner or a non-active parishioner of Saint Joseph Parish, I will support the school by teaching my child(ren) Christian values and the importance of belonging to a Christian community. I/We pledge to be current with our financial obligation to Saint Joseph School. I/We also agree to support Saint Joseph School through active participation with school programs, special events, and special school needs. DATE (MM/DD/YYYY) PARENT / GUARDIAN SIGNATURE CHURCH OR PARISH RELIGION PERSON RESPONSIBLE FOR TUITION PAYMENTS? CHECK ALL THAT APPLY MOTHER FATHERLEGAL GUARDIAN OTHER (IF “OTHER”, PLEASE COMPLETE THE SECTION BELOW) Please return this completed form and the $75 non-refundable application fee for each student to be enrolled for the 2016-2017school year before January 28th 2016 at 3:30p.m. EST. (IMPORTANT: All blanks on all sides of this form must be filled in or application and registration fee will be returned.) PLEASE KEEP ALL REGISTRATION FEES AND ANY TUITION PAYMENTS SEPARATE. TUITION REFUND POLICY The first tuition payment for the 2016-2017 school year is due July 1, 2016. If a child is withdrawn from the school prior to the first day of class, 75% of tuition paid will be refunded. If a child is withdrawn within the first week (5 school days) of school, 40% of tuition paid will be refunded. No tuition payments will be refunded after the first week (5 school days) of school. Any job change causing a family relocation will be handled on an individual basis. (Initial that you read and understand the TUITION REFUND POLICY) PAYMENT PLAN (CHOOSE ONE) FULL PAYMENT (3% discount if received by July 15th, 2016) MONTHLY PAYMENT PLAN (Beginning July 1st, 2016, 11 monthly payments of $89/mo. for the 3-Year-Old Program, $129/mo. for the 4-Year-Old 3-Day Program, and $218/mo. for the 4-Year-Old 5-Day Program. Payments due no later than the 10th of every month, These payments can be made thru on-line giving thru your checking account or your bank with automatic payment withdrawal. A $10 late fee is charged for payments received after.) COST The 2016-17 tuition cost per pupil is $985 for the 3-Year-Old Program, $1,420 for the 4-Year-Old 3-Day Program, and $2,400 for the 4-Year-Old 5-Day Program. CHECK # FOR OFFICE USE ONLY REGISTRATION FEE AMOUNT RECEIVED NOTES FEES TOTAL AMOUNT RECEIVED: All FEES ARE NON-REFUNDABLE CASHOTHER $75 PREFERENCES Please check the session you prefer / children must be toilet trained before entering school): 3-Year-Old Program: Offered Mon & Tues 12:15 – 2:45pm 4-Year-Old 3-Day Program: Offered Wed-Fri 12:15-2:45pm Would you like your name listed on the Pre-School roster that is given to each family in your child’s class? YesNo Would you like your name and your child’s name listed in the Saint Joseph School Directory? YesNo Please indicate if you give permission for your child’s photo to be taken and used in classroom displays, and informational/promotional materials for Saint Joseph School? YesNo 4-Year-Old 5-Day Program: Offered Mon-Fri 8:30-11:00am