St. Mary Preschool

2020-2021 Academic School Year

Non-refundable Registration Fee $75 per family

5 + $326 per month Monday-Friday 8:00am - 11:30am (Full Day $495)The 5+ program is designed to give those children who missed the cut-off for kindergarten or just aren't ready yet, a different experience. It is also perfect for parents of 4-5 year olds that want their child to be involved in a faith filled program 5 mornings a week. This course of study is geared toward the exploration of all subjects and kindergarten readiness. This program also focuses on early literacy skills, math, science, and Catholic Faith Building.

Pre-K $236 per month - Monday, Wednesday and Friday 8:00am - 11:30am The Pre-K program is designed to help your child prepare for Kindergarten. The aim of this program is phonetic awareness and ultimately, mastery of the alphabet. We also offer many experiences in science, math, geography, social studies and art. Jesus time is a special part of everyday; we do a variety of hands-on activities as well as learning our prayers. The children are always encouraged to talk to God about their feelings.

Pre-3 $211 per month - Tuesday and Thursday 8:00am - 11:30amThis program is designed to encourage social interactions that are positive and respectful. The 3 year olds social building skills are developed with Jesus as our model. Our class size is set up in such a way that the children are exposed to large groups as well as small learning groups. This helps them to become more independent and self-confident. They participate in Jesus time as well, and they like to act out stories theyhear from the bible. We also offer early math, reading, and writing skills in our small learning groups. The Pre-3’s begin to learn the prayers that develop our faith and loveof the Lord.

St. Mary Catholic Preschool2222 23rd Avenue, Greeley, CO 80634

Tel. 970-353-8100 • Fax 970-353-8700 “The child continued to grow and become strong, filled with wisdom;

and the grace of God was upon him” (Lk 2:40)

Preschool Registration Guidelines 2020-2021 Academic School Year

Welcome In this registration packet, you will find tuition rates and fees for the 2020-2021 school year. There is a non-refundable registration fee of $75 per family due with this application. Please look over everything in this packet carefully. Your registration will be complete when the following items are turned into the school office. Please fill out each form completely.

Registration will not be accepted until all items are turned in and complete.

Application for Admission

Financial Contract

Copy of annual health physical form from the child's care provider(It is state law that we have this on file before your child is able to attend preschool.)

Copy of immunization record (It is state law that we have this on file before your child is able to attend preschool.)

Emergency Card

Health Questionnaire Permission for Publication of Information/Photograph and Interview Release form

A $75 registration fee per family - This MUST be paid when the application is submitted.

It is our intention to send our child to St. Mary Catholic School K-8th grade

If filling this application by computer, please download and save before entering information.

To complete your registration as a downloadable PDF you must complete the following:

2. Digital signatures are required on all forms.Click on How to Sign the Registration Form Digitally for instructions..ÏÔÅ: Every time you apply a digital signature it will prompt you tosave your forms.

3. Provide requested document (i.e. updated immunization records…)

4. Print out the parish affiliation form that pertains to your family andsubmit to your pastor for his signature. St. Mary parishioners mayreturn their affiliation form with packet. (Registration packets maybe submitted to the school prior to receiving the signed parishaffiliation form.)

5. Submit all forms to the office either through FastDirect, by yourpersonal email to t.perez@stmarycs.net or a printed copy, and

6. $75.00 registration fee (per familyɊ either by check made payable toSt. Mary Catholic School or pay online by clicking the link below. Ifpaying online please provide a copy of the receipt.

Please download this form, ÓÁÖÅ, fill out and ÓÁÖÅ again before making your online payment. (You may want to save as you go along.)

1.

Thank you for registering at St. Mary Catholic School!

The Catholic schools of the Archdiocese, under the jurisdiction of the Archbishop, and at the direction of the Superintendent, attest that none of the Catholic schools discriminates on the basis of sex in its admission policies, its treatment of students or its employment practices Notice of Student Non-Discrimination Policy The Catholic schools of the Archdiocese of Denver, under the jurisdiction of Archbishop Samuel J. Aquila, S.T.L. and at the direction of the Superintendent, state that all of their Catholic schools admit students of any race, color, national or eth-nic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the schools. Furthermore, Arch-diocesan schools admit disabled students in accord with the policy on Admissions in the Archdiocese of Denver Catholic Schools Administra-tor’s Manual. These schools do not discriminate on the basis of race, age, disability, color, and national or ethnic origin in the administration of their educational policies, employment practices, scholarship and loan programs, athletic or other school-administered programs.

ST. MARY CATHOLIC SCHOOL Application for Admission for Preschool Please

type or print in ink and answer all questions completely.

Child’s grade level for school year 2020-2021 Please check one of the boxes

Student Information

Student’s Last Name First Middle

Street/Apt # Home Phone Number

City State Zip County

Birth Place Male Female Birth Date Religious Affiliation Registered Member of (Church/Parish)

Family Background

Father’s Name

Address

Mother’s Name Guardian’s Name

Cell Phone Work Phone

Please provide AT LEAST ONE email address so that St. Mary Catholic School can communicate important information to your family:

___________________________________________ _________________________________________ _________________________________________ E-mail Address E-mail Address E-mail Address

Applicant lives with (Check those that apply): Father Mother

Stepmother Stepfather Other

Please check if applicable: Father Deceased Mother Deceased

1 of 2

* Court Custodial Agreement needs to be provided (if applicable)

Guardian

Cell Phone Work Phone

City, State, Zip

Employer

Employer Address

Occupation

Birthplace

Religious Affiliation

Employer Occupation

Employer Address

Birthplace

Religious Affiliation

Employer Occupation

Employer Address

City, State, Zip

Address

City, State, Zip

Cell Phone Work Phone

Address

City, State, Zip

Birthplace

All school communications will be sent to the address at which the student resides. If parents or step-parents not living with the student wish to be included on the St Mary Catholic Preschool mailing list, please provide information. Marital Status

City, State, Zip City, State, Zip

Religious Affiliation

Pre-3 Pre-K 5+ Full Day

Siblings: Name Age Birth Date Grade School

______

______

______

______

______

____________________________________

____________________________________

____________________________________

____________________________________

____________________________________

__________________________________

__________________________________

__________________________________

_____________ _______

_____________ _______

_____________ _______

_____________ _______

_____________ _______

__________________________________

_________________________________

Please answer the questions below:

Has your child ever been evaluated for Special Education Services/ IEP? ........................................................... Yes No

If yes, explain:

Does your child take any regular medication? ...................................................................................................... Yes No If yes, explain:

Does your child have any medical concerns/disabilities that the school should be made aware of? .................... Yes No If yes, explain:

Information for St. Mary Catholic School and Archdiocesan use only: Please check the appropriate box in each column:

Student’s Race Background: Student’s Ethnic Background: Hispanic/Latino Non-Hispanic/Non-Latino

Native American Black Asian White Hawaiian/Pacific Islander Multi-Racial (please list all races)Other (please indicate) ____________________________________

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I hereby certify that the information presented on this form is true, accurate and complete. I understand that it is my responsibility to update any and all information as it changes.

________________________________________ ________________________________________ Signature of Father or Guardian Date Signature of Mother or Guardian Date

A check for the registration fee of $75.00 should accompany this application. This is a non-refundable fee.

________________________________________

The Catholic schools of the Archdiocese, under the jurisdiction of the Archbishop, and at the direction of the Superintendent, attest that none of the Catholic schools discriminates on the basis of sex in its admission policies, its treatment of students or its employment practices Notice of Student Non-Discrimination Policy The Catholic schools of the Archdiocese of Denver, under the jurisdiction of Archbishop Samuel J. Aquila, S.T.L. and at the direction of the Superintendent, state that all of their Catholic schools admit students of any race, color, national or eth-nic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the schools. Furthermore, Arch-diocesan schools admit disabled students in accord with the policy on Admissions in the Archdiocese of Denver Catholic Schools Administra-tor’s Manual. These schools do not discriminate on the basis of race, age, disability, color, and national or ethnic origin in the administration of their educational policies, employment practices, scholarship and loan programs, athletic or other school-administered programs.

St. Mary Catholic PreschoolFinancial Contract

2020-2021 Academic School Year Evaluated Monthly for Adherence

Method of Payment:

Fees: All Non Refundable Registration Fee: $75.00 per family

Tuition: _____ Pre-3 Initial

_____ Pre-K Initial

Initial

Family Name: ________________

Initial_____

Initial

Payment made annually by September 16, 2020 with a 5% Discount

______ Payment made in three equal installments (September 16th, December 16th and March 16th)

______Initial

_____ 5+ Initial

$211.00 per month or $1,899.00 per year

$236.00 per month or $2,124.00 per year

$326.00 per month or $2,934.00 per year

I(We), __________________________________________, as the parent/guardian of __________________________, at St. Mary Catholic Preschool, choose the following payment option: (Please initial choice)

It is the responsibility of all parents to pay their tuition on a timely basis. If your tuition is not paid by the last day of the month, you will be asked to schedule a meeting with the principal.

If your tuition for this school year is not current, you will not be allowed to register for next year until it is brought up to date.

In order to keep tuition affordable, participation of our school parents in Scrip and fundraising is requested. - Everyone will be requested to purchase $5,000 of Scrip over the year or pay a $250 donation to the school, or

a combination of scrip and fundraising thereof. You can solicit help from your friends and family to help you meet the scrip requirement. Scrip is available throughout the year in the parish office Monday–Friday, 8:00am to 4:00pm. (Monday-Thursday during the summer.)

- It is requested that all parents participate in fundraisers.All parents are encouraged to give of their time to help with school activities, committees and other events.

Father/Guardian Name (Printed) Father/Guardian Signature

Mother/Guardian Name (Printed) Mother/Guardian Signature

Business Manager

Pastor Principal

Preschool Director

Date

Date

Date

Date

Date

Date

_____ Initial

*Catholic Families

$495.00 per month or 4,4550.00 per year

*Non-Catholic or No Parish Affiliation$530.00 per month or 4,770.00 per year

_____

Initial

Full Time Students

St. Mary Catholic Preschool

Health Questionnaire 2020-2021 Academic School Year

Please fill out completely, IF YOUR CHILD HAS HEALTH CONCERNS. Write “N/A” if your child has no health concerns.

Student’s Name _______________________________________

Date of Birth ___________________ Male Female

Parent’s/Guardian’s Name ______________________________ Phone Number _____________________

Please list any health concerns the school should be aware of (i.e. Asthma, allergies, diabetes, physical limitations, etc): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

My child wears: Glasses Contacts Neither

List of Medications _________________________________________________________________________

(If medication is required at school an Authorization to Administer Medication & LAPP Authorization to Administer Medication in School must be filled out by parent and doctor.)

Dosage (times and quantities) ____________________________________________________________________________________Will medication need to be in the clinic at school? Yes No With the above listed health concerns, please list in order the actions you want taken if a related problem develops while your child is at school:

_________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________

________________________ _______________________________________________ Parent/Guardian Signature Date

Doctor’s Name __________________________________ Phone Number _____________________

I understand that I must keep my child's health and immunization records up to date with current information. If necessary, my child's health care provider may be contacted to update health and immunization records.

St. Mary Catholic PreschoolPermission for Publication of Information

2020-2021 Academic School Year We provide a variety of lists that include family address and telephone number. (Family Directory, etc.) If you prefer that your phone number and/or address not be provided in this way, please check the appropriate box.

No I do not wish to have my telephone number and/or address published for any reason. Please list any other information that you do not want published:

____________________________________________________________________________

Yes You may use my telephone number and address in published lists. This includes the School Directory. Here is my information as I would like it to appear:

Photograph and Interview Release 2020-2021 Academic School Year

I hereby grant consent to use and release to the Catholic Archdiocese of Denver and St. Mary Catholic School the use of my name and likeness and that of my child/children, whether in still, motion pictures, audio and video tape; my photograph and photos of my child/children and/or reproductions of me and my child/children including our voice (which includes commentary, remarks, and/or recordings); our features with or without our names, for any promotional purposes involving the Archdiocese and/or St. Mary Catholic School, for news and/or feature stories in the Denver Catholic, El Pueblo Catolico, or other media (which includes Internet, print, radio, television) or for other purposes whatsoever, except for the endorsement of any commercial products.

These items may be used without limitation or reservation of any fee.

Minors cannot consent to media interview or waive their privacy right. These decisions must be made by the parent/guardian; therefore, this release form must be signed by parent/guardain when the individual is a minor.

Parent/Guardian Information

_____________________________________ Print Parent’s/Guardian’s Name _____________________________________ Parent’s/Guardian’s Address _____________________________________ City Zip Code _____________________________________ Home, Cell and/or Work Phone Numbers

Child/Children Information

_____________________________________ Print Child’s Name Grade

No, I do not want my child/children photographed and/or interviewed for any reason.

Yes, I do give permission for my child/children to be photographed and/or interviewed.

_____________________________________ Parent/Guardian Signature

_____________________________________ Date

No, I do not want my child/children photographed and/or interviewed except for the school yearbook or within the school.

_________________________________________________

_________________________________________________

_________________________________________________

Mother's Name

Mother's Street Address

Mother's/Guardian's City, State & Zip Code Mother's/Guardians Phone #

_______________________________________________

______________________________________________

Father's/Guardian's Name

_______________________________________________ Father's/Guardian's Address

Father's/Guardian's City, State & Zip Code Father's/Guardian's Phone #

St. Mary Catholic Preschool Emergency Card

Academic School Year: 2020-2021

Student’s Name______________________________________ Date of Birth ______________________ Street Address _________________________________________ City _______________ Zip__________

Male Female Home Phone _______________ If Catholic, Parish Affiliation ________________

Parent/Guardian Information In case of an Emergency or Illness, who should be contacted first? _____________________________

__________________________ ______________

Address Work Phone

__________________________________ _________________ _________________ _________________ _______________________

__________________________________ _________________ _________________ _________________ _______________________

__________________________________ _________________ _________________ _________________ _______________________

Specific Persons NOT Authorized to Pick-Up Child Last Name First Name Relationship ______________________________________ _________________________________________ ________________________________ ______________________________________ _________________________________________ ________________________________

Medical Information Heath Conditions (such as asthma, diabetes, allergies, epilepsy, heart disease, contacts, etc.) _______________________________________________________________________________________ Current Medications: _____________________________________________________________________ ________________________________ ___________________________________ ________________ Child’s Physician Address Phone ______________________________________ __________________________________________ ___________________ Child’s Dentist Address Phone

Medical Authorization

Student Records Update I understand that I must keep my child’s records up-to-date with current information.

______________________________________ _

______________________

I give the school my permission to take my child to a hospital to receive emergency treatment. I hereby consent to any x-ray examination, medical or surgical diagnosis or treatment, and hospital care to be rendered to my child under the general or direct supervision and upon the advice of a physician and surgeon licensed under the provisions of the Medical Practice Act. I also consent to any x-ray examination, anesthetic, dental or surgical diagnosis or treatment, and hospital care to be rendered to my child by a dentist under the provisions of the Dental Practice Act. I authorize the medical facility to release my child into the custody of a school representative should hospital care no longer be needed. I understand that this is only in an extreme emergency and when the parent or legal guardian cannot be reached. I understand that I am responsible for any expenses incurred by the medical and/or dental diagnosis or treatment. I agree to pick up my child if he/she is sick or injured. If I cannot be reached, the above emergency contacts can be called to pick up my child.

__________________________ ______________

__________________________ ______________Mother/GuardianFather/Guardian Home Phone Home Phone

__________________________ _____________ City, State, Zip Cell Phone _________________________________________ Employer _________________________________________ Work Address, City, State, Zip

Name Home Phone Work Phone Cell Phone Relationship

Emergency Contact Authorized to Pick-Up ChildUnder no circumstances will your child be released to anyone not known to the school without verbal permission from a parent or legal guardian.

Photo ID may be required.

______________________________________ __________________________________________ __________________ Hospital of Choice Address Phone

__________________________ ______________

__________________________ ______________

______________________________________________________________________

______________________________________________________________________Work Address, City, State Zip

Employer

City, State, Zip Cell Phone

Address Work Phone

Parent Signature Date

AUTHORIZATION FOR EMERGENCY MEDICAL CARE:

* PERMISSION FOR PARTICIPATION IN ACTIVITIES:

*

*

Parent/Guardian _________________________________ Date ______________________________

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St. Mary Catholic School ANNUAL AUTHORIZATION FORM

*

I, _________________________________ hereby give my permission for St. Mary Catholic School staff to call for medical or make surgical decisions for my child _____________________________ should an emergency arise. It is understood that a conscientious effort will be made to locate me before emergency action or decision will be taken, but if this is not possible the expenses of emergency medical treatment or care will be accepted and paid by me.

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I give permission for my child/children to participate in all program activities except for the following:

_____________________________________________________________________________________

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PERMISSION TO USE: Sunscreen Yes No Bug Spray Yes No Lotion Yes No

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MEDIA USE: My child/children may participate in the use of media as listed in the contract and any provider deemed appropriate computer/video games. There will be no higher rating than E/G for any of these items. Yes No Except following: _____________________________________________

PERMISSION FOR TRIPS:I give permission for my child to go on trips away from the premises of the St. Mary facility in the company of a responsible adult, whether on foot or by vehicle. Yes No

*