St. Mary's School tie ee Education For Life..Faith For Living Enrollment Packet for 2016-2017 Contents: 4. Envollment Packet 2. Mission Statement & Admission Policy 3, Registration Form 4. Health Record/Modical Treatment Release Form 6. After-School Transportation & Publicity Authorization/Ethnicity 6. Tuition Assistance Qualification Procedure with attachments* 7. George & Mary Kremer Foundation Application* 8. Tuilion Schedule 8. Tuition Contract 40, Tuition Contract continued 41. Parental Involvement & Fundraising Contracts (Kindergarten ~ 8" Grade Families) 42. Parental Involvement & Fundraising Contracts (Pre-School Only) 48. Concussion Information Physical Education Permission Form + Use the following forms only if applicableMission Statement ‘Guided the Holy Spe and in partnership withthe pret, St. ary’ Scho commited teaching he nowledge of the ith centered in the person ffxi Crt The vals and tration ofthe Ctl fat te inept in aconpreense sale papam where ach lean develop spay, mele, virally ssa and physical. Ina sa joy aed verse eaionment, Se My’ Scheel wil eck students the vata tet Ctl heritage ile respecting the acon of sudens fer Fath Our Asin tte i veined anual. Please contac the editor ion have ay queton oF ‘esmmendatons regarding Mision Statonent. Rete 122203, ADMISSIONS POLICY: 51, Mary's Schoo is open to any child whose parenis/guncians desire Cristian education fr thie child ‘Studens wil be admit St. Mary's Parish Catholic Schoo cording to the fllowing erie: 1. anuary 1%1S"reiscaton wil be aeceped forthe upeoming school yar starting with eilren of existing St. Mary's Cathie Schoo families, Pre-K ~8. 2. Sanuary 165-30" registration wil be open to Catholic parishioners of The Diocese of Marqute, Po, 3. February P, registration will open tothe publi, Pre-K. A nonrefundable deposit of $75.00 fr K-8 an 35.00 For Pre-K wil be required tthe time of registration to reserve the spot. Registration fees are due by April". After April", ‘egistration Fees are doubled to $180. ‘Kindergarten students must be 5 yenrs old by September 01 ofthe year they inlend fo esr Kindergarten, Exceptions are made Tor ctldren whose birthday fils on or before Deceter 31% and show readines, verted bya formal assessment and preschool teacher. lasses become filed to capacity, any openings that occur wil be fled fom a wating lis. The ‘sting ist wil be compile on a ist come frst serve basis, Registrations will nt be taken afer the fst day of schoo excep inthe ese of ilies now tthe sre or under eatin considerations with consultation ofthe St. May"s Education Commission. New Students wll not be admit inte Grae 8 excep under special circumstances and in consultation of {he Seco! Commission. PreSchool students must be3 by September 1. Any openings that coeur wil be filled from 2 ‘wating list. The waiting lit will be compiled on fist ome, ist serve basis. ‘Transfer students: Trasfer students shal be admit to other grades upon evidence oP having ‘slsfictorly completed previous grade levels **Please note that kindergarten entrances base onthe ae policies completion ofthe preschool program. Revised: 923/218 ed for kindergarten, not uponTr [De Pai ee Inia ‘otis ey Registration Form ‘Student Information (Chis Name (Last) (st) ‘iste, Date of Birth Sex NIF Gade b Fal Primary Sudan srs ca. Is your child a retuning St Man's Cathotc School Student YES oF NO ‘AWow Student YES oe NO. “Wow tents peace allah a enpy of Birth conifeate and immunlzations Eaunily Hnformation ParenGuaraon ParenuGuardion 2 Pee of Employnen cexpation, Marital Sos Phone). 0) Info St Marys St Joseph's ter, ‘Non Gathale ‘em yr conor t ntce pash _(yes) (on) New students please complete this section: Lstal eeho0l previously atended School year Grade__ School _CtyStateHealth Record/Medical Treatment Release Form Name pos. Does your cil have any chronic ness? YES or NO Name of ips, entity dats and causes of any operations, hosplialzation, sigifcant injures your child may havea ‘oes your cil ave or aay reoiclons cling Phyatal Caton asst VES ee NO 1 Yeeshat are hier restictlons? My cil isin good heath YES or NO My cil is caren on allimamunizations YES or NO SL Mary's a copy of my cits immunization reorde YES orNO. Wear gasses YES or NO Date of asteye exam _ Hoss earing problom YES eNO 1s thao anything oo wo shouldbe aware of? YES or NO LUst alee, medications Please provide your name, address and phone numbers) a2 people we can callin an emergency i ‘you cannol be reached Parent Name eres Phone “Bea pareaTigardian | do hereby suze ho Weatnant bya quale ad Teansod Nadal Dostr na emergency which nthe opinion af th attending pysiean, may endanga hifha Wf, cause a dsigurenors, Bysealimpalment or undue discomfort if delayed. Ths auhoriy is granod oly air aroasenablo fot has Paseaiusrian Signature ate Healy Insurance Information: Company Poli. Group Poliey Holder —‘Transportation - Please check any that apply: _My child wl wale home oro day care prowdor iter the After Sahoo! Program Ride the bus tome oro day care prowder Bo picked up by parerilqvardian or day care provider otra 1 your chilis bring picked w by someone oer tan he pain lense wt al hemes nd telephone number he pena) wh ve sulorzation pick up your child sou child i pc pb 3:25pm, we wl cal he oop on i Name. Phone. “Ave here any spacial ereumstncas that we should know of? I spac fe school arrangement ests ets nat std on his paper, plaese nol your child's teacher immeclaelyinwiting. YES ono Picturefinternet authorization ay wo take yout child's picture for use in tho school newaltes, yearbooks, mula rosentatons, brochues, ers, ci medi sites, of for adminsralon purposes? YES or NO May we post pictues of you chil on he schootswebate which is pubic? YES or NO "May we pubsh your name, ads, and phone in the schol decry? YES or NO "May we give your name an email o ou Home A School Assocation? YES or NO ‘Special instructors Ethnicity/Race Te folowing information Is optonel butt halps oe school for specie rants and lk allows for ow schoo to paricpat Inthe share-time programs wth he Saut Ave School CoucesianWhita __HipaniiBlack __American inganiNatve Alaskan _ Hispanic Whito sian MU Rce "Black Naive Hewaian'Pacfe Islander _ vida Eastrn Parent's signature Date‘Tuition Assistance Qualification Procedure + Faies who unify fr feo ede shal lances scoring tthe feral gudelines (ce eerie) gestion ean ot Nas Scholes th oa an he el tae Iso of siunce, ust presen a leterexlaiing fuies nal i + Families tt Mory’s Stool whe wish 0 aply fort ssistance forthe nest school ea, us subait ‘he Stadt Gran Parent Form a2 copy of Trcome Tox Retr 040 frm oa soue of po af fname, era ey 15 ‘he faowing eee: 1 aniles wh qi for fc ach nde the feral ietns wil pay $650.0 pr fail per year sn wb given fist conser, 2. anil who gait for reduced ach unde the federal guidlines wil yay one-half the lft lain sd wl be gen sean coasderstin. 3. Families who doo il unde these guile, but arin seed ofesisanc willbe given auton ‘rd depending he amount of money let inte budget for lon estan and tent by & feoxnivee comprised of past, edmiistaor and fatal commitee member. 4A. “These frm rion ansiance awards ae mbt o change depending onthe ner of eet reccvedincah particule yar and he smoot of money aval in he tion stance fa. 5. Allin ameuat an be aid in islets touout the cen school ys. Cleon of hs {un wl bellowed nthe sate manera the aon Colleton Ply 46, The proces willbe confidential the scoot Serta, school Administrator and Tian Award Comite, receive a scholarship or tition assistance. ly must validate how they volunteered during the past year to be eligible to Income Eligibility Guidelines rota! Twice every Twice Every Famly pe Two per Two. See’ Anmsal Monthly Month Weeks Weekly Annual“ Monthly Month Weaks Welly 1 [15,301 [#276 | 9638 | $509 | $295 BH 421,775 | e1,015] 4908 | $038 | 419 2 [$20,708 | $1,726 | $063 | $797 | $399 [eel $29,471 | $2,456 | $1,228 | $H,134 | 4507 3 [$26,157 [¥ZA7F | 1,088 | $1,008] $503 PA $37,167 | $3,058 | $1,599 | $3,430 | 47E5 & | 81.508 [aoana far ane [gars | S607 fad daa nas | SETS] SLAM] HH, 7Pm | RAT 5 | $36,933 | $3,078 | $1,539 | $1,401 | $711 feat $52,559 | $4,380 | $2,190 | $2,022 | $1,011 6 | $42,341 | $3,529 | $1,765 | $1,629] $8i5 fal $60,255 | $5022 | $2,51% | $2,518 | $1,159 7 | $47,749 | $3,980 | $3,990 | $1,837] $019 fay $67,953 | $8,068 | $2,832 | $2,614 | $1,307 @ | $53,457 | $4,430 | $2,215 | $2,045 | $1,025 fag 475,697 | $6,304 | $3,152 $2,900 | $1,455 5408" | $451* | $226" | $200" | G10s [EL ¥7,696"] F426! ¥a0i] $296") “SLa8"|coe and Mary Kremer Foundation Parent Application for Student Grant Only on fom aie per aia ito be fille out by pets ui “This fom shoul ile ut nd signed by the partsor garam fuels sled este ton grant This fom shuld be reumed to he sebol (ot he Foudaton offic) opt wha copy the parents 2015 income Tax Return Form IbWD ooshe aplable ienmeverfeton. (Capes of sopping RS sche ‘nent rece). [APPLICATIONS SUBMITTED WITHOUT INCOME VERIFICATION WILL NOT BE ACCEPTED ane — Bien) (Sinden) ‘ialest) (Gente) ‘only list ames of students in houschold applying for tition assistance. ity hime (w! aren code) 1 2 ET feo stall dependent of hea of scold oad cclatonshipto hea ef Hornbol 1 2 DepENTEN—reonsp Heat or Honshetd > DeSENEN KERMA TSHERTOT HUH RET RETOTRRTOTTRT ep — RENTS HERE TTS JT RFOTERTOTRY T ARIF TTT OTR ‘Depeniew —Rehosip i Hewat Howalald Depenfeot _ Reaiowsip io Hed of Houehal ae of Fathers Bpoyer ‘ama comes Name oF Mathers Employer Ant incomes ‘fhe Souter of coe (chilsupor, alimony wen dsb st Soutee: “Anal Anca 8 “TOTAL NOUSEHOLD INCOME FOR 2015 «S "NOTE Piss atch a spy you Fedral income Tax Reta For L040 or Ore nce Veriton Fo 21s [NOTE: ALL ITEMS MUST E COMPLETED OR THIS APPLICATION WILLNOT QUALIFY. ‘Wecerif tat he ifooaton contained on tis api ier, and hereby grate Advis Boa of the onrge st Mary Kremer Foumlalon nd whichever fn they copy, pen to cbs oc infomation ano verify thiseredit egy andanyapplieablcret repr. Weslo gran eth igh to ‘ew oncom a etn fe teat Yea 2015 seta very he tna ove ‘Wealso crf tha ished ire needy ecortng the guidelines ease bythe George ad ‘Mary Kremer Foundation Rosell income doesnot exceed the Feder Pod Program Maxima Faily Income for Reed Priced Meas of $4,853 per yer fora honshol size fo ass eres by STG54 foreach alder fly rene over the mere seni in he howl) ‘Sigs ofFateror Guin = Signe of Morar Go-GoTUITION SCHI ULE 2016-2017 Registration Tuition _10 Monthly Payments*_12 Monthly Payments* Parishioner Rate TChild $75, s2ai0 $241.00 $200.83, 2" Child $75 si910 $191.00 $159.17 3" Child $75 $1200 $120.00 $100.00 Non Parishioner Rate TChild $75 $3600 8360.00 $300.00 2"Child $75 $3100 $310.00 $258.33, 3"Child $75 $2270 $227.00 $189.17 Pre School Rates Per Child 1590.00 $159.00 $132.50 SMART TUITION onetime fee of $43 will apply per family, for families paying throughout the year (the figures above are examples of payment plans, however, SMART. TUITION has the flexibility of providing different plans which best meet vour needs) SMARTTUITION onetime fee of $20 will apply per family paying onetime full t SMART TUITION late/missed payment fee $50 K-8 Registration Fee ~ $75.00 per child prior to April 1, After April 1, $150.00 Pre-School - $35.00 per child prior to April 1, After April 1, $70.00 Registration Fee is due at the time of Registration. The monthly payments do not include the Registration Fee. IMPORTANT Families claiming parishioner status must be able to demonstrate active participation in the life Of the parish through weekly use of tithing envelopes and their presence at Sunday Mass. Parishes will verify active membership before the beginning of the school year. Information on SMART TUITIOM may be found at info@smarttuition.comFAMILY ID #: FAMILY NAME: Tat Fist Name(s) ST. MARY CATHOLIC SCHOOL TUITION CONTRACT For the 2016-2017 school year, | commit myself to pay the tution and fees as follows: (A) Tin easter em aca aust hee) 8 Foes anaes are cal adstment sheet) 8 Sorp creat 6 Teton Asistance/Seroarhp Cost « ) TOTAL ner Turion A Pease choose ona! he payment opt bln (pton: Ono tine fll amount payment ° "Payer wt be made deco SMART TUITION opton2: Monthy paymants Mot\ payers il be mage deel o SMART TUTION | age to enol in SWART TUITION forthe processing and collin of talon and fees forthe 2010-2017 schoo Sonate _ ae: Pare, Guardar ar Paison wo Fala Response Revawed at Serato Pa Popeye at‘ST. MARY CATHOLIC SCHOOL. LOCAL ADJUSTMENTS 12016-2017 School Year Partpaing Ctatie Non Parteipsting Cate Nontaate at ore ate] aE PRK Tendon Namest)of Stents) FUTON FoR THE YEAR WILL BE: se (Aj transfer thi gure tothe ation contact owe: Registration Fee [due atte of apletion) 5 ‘Smart Totton Fao (Ons $20 fo for owe payent OR: Online fe fr s ‘Scheduled payments), FEES FOR THE YEAR WILL BE: {@hiranster ts gure to Os ult contact “ulton Commitment statment Pease check one statomant ar sign conmiiment) Jama paishionr Caolcpaa have rad and signed he Talon ‘ont ny Region Pact ori to demoncrte nto ‘artrpaton ine ot preh erg ner presence at ‘Sunday Mas. Your paish peso pce rpresentaive wil sgn the Talon Contact a verfeation of {ote partepaton, a nen-exehlansr. | have rood and slgod te Takon Corr in my Reston Pack ‘ind Name ier Paes —Ce Pa i 0Parental involvement Contract (Kindorgarton - 8” Families) Parental involvements also essai fr kegping ution costs as low a possible ain creating the fant atmosphere ‘9 importan| othe schol mission. Ati. Marys Cathae Schoo, each amy is required to give minimum of 30 ours (18hour for preschoo! amie) annus of voknier serves, Far tofu tis commitment may proven the stint Irom rtuning to St Mary's Cale School tho folowing schoo! year. Parents NUST contac the Penal extenuating ‘Greumstanat prevent them Kem ailing his comment. The are many opportunities or you to become volved a St May's Cathe School please contact the rant ofa, lasreon leacher ar HAGA vluntercoordntoro eee How you can gol inves Its the responsibilty ofthe parents to reotd their own volunteer hours using the recording method avalabe, Votniaer service Nous canbe eamod by parents or latves 18 years of age or oer, but may net be transferred to another aly. All voluniors having doc contact with our students wil nee to comple a VIRTUS training ~ “Protecting Goss ‘Chidron. A background check and DHS contra regis clearance report wl be requved tobe on fe a wel Confdentitty Confidentiality sof ho uimost importance in your association wth teachers and students. What you se or heart tho “schools private, Sent you observe in he classroom or school cat be discussed wih other paren (oven ft ‘hi’ parents), facut or staf. You must always refer any questions regarding stadets at S. Marys Catole Schoo to the ch’ teacher or Pipa Fundraising Contract JACKPOT RAFFLE (Kindergarton- 6 Famil *) ‘The Jack Pot Rae isa mandatary fundraise. The money generated fom the fundraise isa component of eur budget. Therefore, everyone is required to partipate oto pay an equivalent in eu of patting the fundraea, Each faye requied to sll 25 texas o make a singe payment of $500 Il you choose to make the single payment, sd tthe ta you fogsor your hl forsee! (youl en be abe to Koop 25 Uckets {or youre to enti he drawing). We WILL PARTICIPATE IN THE JACKPOT RAFFLE AND SELL 25 TICKETS BY THE RAFFLE DEADLINE, we. WILL BE PAYING 8500 IN LIEU OF PARTICIPATION IN THE JACKPOT RAFFLE. Last Name. Phone Number Fathers Name Adoress Motners Name Ema Students Name(s) _ Grade {We undorsand ard ares patent wale and nding are important pars of St Marys Cathal Schoo, UW accept mylour esponsibilly tii reqdeoment st eth by te Sahoo! Commission Signature ate Sionatue DateParental Involvement Contract (Pre-School Only) Prenialivvament is also essen for keping tutton costs as lows possible and in resting the fal atmospre ‘0 mporant othe schoo mission. At St. Marys Cathac Scheel, each family required to give a minimum of $0 ours (Shout for peechoo famies) annual of volintoar servers. Fale to uf this commitment may prevent tho student from returning lo St Mary's Cathovo Schwa the folowing schoo year. Paronts MUST conact Be Principal f extenuating ‘oumetancos preven hem fom fling this commitment The ae mary epporunies for youte become valved at ‘St Marys Cathe School please contact he fet ofica, lasso laachor or HASA volunler coordnaor to se haw you can got involved itis tho responsbiyof tie parents to cord tne own voluntar hours using the racrdng method avaabe, Voknteet serve hours canbe eared by parents or eaves 18 years of age o oer, but may nol be Uansfored to another family. ‘A volunteers having rec contact with cur ston wl ned o complete @ VIRTUS valning~ "Protecting Goze CChidre’ Atuacground check and DHS central ris coarancerepart will quired tobe on te as Wel Confidentitty Confident sof he umost importance in your association with weachecs and students. What you se orhesr atthe “choolis private. Students you observe inthe lassroom or echool cant be dzcuseod with other parents (oven th ‘hls parents), fecuty or eta. You mus ahrays rele any quoaine regarding slodets st St. Mars Chole Schoo to {he ches eachor or Pinal Fundraising Contract JACKPOT RAFFLE (Pre-school Only) “Tne Jock Pot Rao isa mandatary funiaiser. The money generated eam the fundrasoris a component of our budget. Thorofre, everyone i requed io parilpato o: to pay an equivalent in a of partkipatng in he fundsier. Each family equiv to Sell 12 Ukets or make a single payment ef $240. I you choose to make ‘he single payment due a he timo you reaistr your ch for sehen (yu wil hen be able to Koop 12 tekots {or yours tonto nt the rain). we. WILL PARTICIPATE IN THE JACKPOT RAFFLE AND SELL 12 TICKETS BY THE RAFFLE DEADLINE wie - |WILL BE PAYING $240 N LIEU OF PARTICIPATION IN THE JACKPOT RAFFLE, Lest Name. - Phone Number Fatners Nome. ross Motners Name, Students Name(s) rade le undorstand aid aro thatparont ivan and funding are important pais of St Marys Catholic ‘Scheo We aceapt my esponsiiltyof the requirements sa fet by te Schack Comission, Signature Dato - Slgnatwe DateCONCUSSION information sheet ‘This sheet has information to help protect your cidren or teens from CONCUSSION concussion or other serious bran injury. Use thsinformation at your childrens lor teens games ad practices ta lea how to spot a concussion and what 0 olf a concussion occurs. What Is a Concussion? ‘Aconcution typeof rustic ban yor caus tyaburg lon orotate head or by alto the body tat uses the head ava wo move ql bckan ft Tis fast movernert can case the bean bence wound ot testa retng ceria changes inthe rain nd sometimes 'svtching a maging the acl, How Can Help Keep My Children or Teens Safe? Spent are a reat way fr chen an teas to stay hey and canhelpthem de welin schoo Top owe your cde orton chances af geting concssoncr ete seaous an Injury. yo soul: + Hep cent a cure of safety fr the eam, > rk thi coach each ways to lower the chances ‘of gating aconcusion, “Takth your cldren or tens about concussion ard hk they have cancers abou reporting cones, Tah them about thet concer ere the Inpartancetrepering cancun andahing Umea recover om one Ensrethat they foto thei eves eset an there of he spot Telyou chen or ensayo expect them practce goed spartenarip tal mes. + When appropri forthe spot or acy. each your ‘tenor eestac thy mus wear a eto loves the chances ofthe most serous pest brah heady oeve here no Concussion x00 met So, even ttn helt tc eportsnt och si tenet 0s isto thee Tee cetey How Can | Spot a Possible Concussion? hitter an teens who show rept one of mare ofthe ns ‘sndsytoms sted belon-—or spy they ot oe ‘ight ter abun blow orto heed or bady—mayhave ‘concen or ther serous ban ry. ‘Signs Observed by Parents or Coaches * Ropers dazed or unred + Fomgetsan struction conus about anasienment or sn ors unsure ofthe gece a epponen + Moves dry, + Answers questions son + Lots conscousnes en ry + Shows mead, behavior personaly changes + areal eves oto ae io Symptoms Reported by Children and Teens + Headache ar presen, + Nose oF vritin, + func gables er dzznes double rly von + fathers byight er nose. + Feeling suo hay oy. cr ony. + Confnion o conentationomemay probs, + st not Yeeng iho elng down’ Talk with your children and teens about concussion. rei them to report thelr concussion symptoms to you and thelr coach right aay. Some chien and teens think concusslons are serious or wory ‘hat they report a concussion they wil lose thelr postion on the team a look weak Be sure fo remind them tha Its etter toms ne game than the whale season. ee Eee To learn more, go to WWW,.cde,gov/HEADSUPWhat Are Some More Serious Danger Signs to Look Out For? Ince cases, a cangeous cotecton of blood fhematona may fer onthe bea ater a burp ow oft the head body Scan sue eta ata esa al 92 ae our cid ore the emergency depart ah ony Mera burp bor ero othehesdor bod he or hes fone crmor ofthe danger gn: + One pupilgethan the che. + Drowns rity to wake wp + Ahesdahe that getsnorie and does ot go aay. + Slueed speech, weolness numbness or decreed ‘coordination, + Repeste vomiting a nausea conmions or seus [eming orth + Unga bhav ceased cofsin resesses oragtaion + Lossfcondounes sed outinoced out Even a treo of concurred tale sey Cotta Concussions affect each child and teen differently. white most children and teens with a concussion fel better within a couple of weeks, some wil have symptoms for ‘months or longer. Tak with your children’s or teens’ health cae provider if thet concussion symptoms donot go away rif they get worse after they return to thelr regular actives. [CONCUSSION] ‘What Should | Do If My Child or Teen Has a Possible Concussion? a parent yu think orci or een maya ‘concise you shou 1 ameve your children fom pla. 2. Heep your chico ten out of lay the dy of th uy Your ld or teen al be seen ty a eat cate proier and eniy ten top with persion eae ae prover whois expeencdin ewan er cancion, 2 Askyourcilorteehekh ae poirot Inston on ping your enor ten etn schoo Yu can qe the nts to your cis or en's schoo se ad echo and tuto ply stn wothe ‘coach dr attain Donot wy jue thesevsty hein yousetCriya lth ae provide shut asssa chi ote fr posible Vaneussen Concussion sigs andsymptomsoien show up seen fe they Bt you may at now hw Seuss conan istfiscand ome syngas may no show up or haus dy, Thebiah ned neo he aera conciton Acids or ees retun toschol nd pate shad be rail proce at ‘ally ranged an more yal care roi To learn more, go to wwwede.gov/HEADSUP ‘You can ako download the COC HEADS UP app to get concusion information atyour frnjertps Just scan the GR code pictured atlet with your smartphone: | confirm that (or my cil) n good health and can participate in Gym Clas. Ay ining hore, state that have read thicwhole page and agra tothe teens (teamed about concusin and talked wth ny patente oach about what o dof havea concussion or othe srous brain inns [ote Name Pine iit Signature ot (© have ead he fc set forpaents on concussion with my ehidor teen anda abou what to doi they have aconcsion ‘orcther serous brainy. Pato Legal Guan Name Pred Pat or Leal Gurin Sante ae: