St. Mary Catholic School 2351 22nd Avenue, Greeley, CO 80631

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)

New Student & Kindergarten 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 $225 per family due with this application. There is also a non-refundable $150.00 book rental/supply fee per student due by August 1, 2020. Please look over everything in this packet carefully. St. Mary endowment fund information will be available upon request. If you think you qualify, please ask the school for an application. 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. (The Family Out-of-Parish Affiliation form can be turned in at a later date, upon pastor signature.)

Application for Admission (one for each child) Parish Affiliation Confirmation (one per family) Please fill out the form that applies: ~St. Mary Affiliation Confirmation form - to be filled out by St. Mary parishioners or ~ Family Out-of-Parish Affiliation form - to be filled by parishioners of all surrounding parishes Please take this form to the parish in which you belong. You will be charged the non-catholic rate until we receive this form signed by your Pastor. The parish will either give you the signed form or return it to our office

once signed.(Application may be submitted to the school prior to receiving the parish affiliation form.)

Financial Contract (one per family)

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

Copy of Sacramental records (Baptismal, Reconciliation, First Holy Communion, Confirmation)

Emergency Card (one for each child)Health Questionnaire (one for each child)Permission Sign-Off/Dismissal Information form (one per family) Permission for Publication of Information/Photograph and Interview Release form (one per family) A Request for Records form needs to be signed if coming from a different school

$225 registration fee per family - DUE AT TIME OF APPLICAION

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. $225.00 registration fee (per ÆÁÍÉÌÙɊ either by check made payable

to St. Mary Catholic School or pay online by clicking the link below.If paying online please provide a copy of the receipt.

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 ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the schools. Furthermore, Archdiocesan schools admit disabled students in accord with the policy on Admissions in the Archdiocese of Denver Catholic Schools Adminis-trator’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.

1.

Thank you for registering at St. Mary Catholic School!

Please download this form, save, fill out and save again before making your online payment. (Make sure you save periodically.)

ST. MARY CATHOLIC SCHOOL

Application for Admission for Kindergarten and New StudentsPlease type or print in black ink and answer all questions completely.

Child’s grade level for school year 2020 - 2021 ______ Previous school (If new to St. Mary Catholic School) School Name School Address

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 Date/Sacraments Received: Baptism

First Communion

(Church/Parish) First Reconciliation Confirmation

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

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)

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 School mailing list, please provide information.

Guardian

Cell Phone Work Phone

City, State, Zip

Employer

Employer Address

Occupation

Birthplace

Religious Affiliation

Employer Occupation

Address

Birthplace

Religious Affiliation

Employer Occupation

Employer Address

City, State, Zip

Address

City, State, Zip

Cell Phone Work Phone

Address

City, State, Zip

Birthplace

How would you like to receive the Parent Newsletter?

All papers in the Wednesday Communication Envelope

Electronically by way of FastDirect (school online communicaiton system)

Marital Status

(Choose one)

City, State, Zip City, State, Zip

Religious Affiliation

City State Zip

Age Birth Date Grade _______

_______

_______

_______

_______

Siblings: Name

__________________________________________

__________________________________________

__________________________________________

__________________________________________

__________________________________________

_____________ _______

_____________ _______

_____________ _______

_____________ _______

_____________ _______

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) ____________________________________

2 of 2

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 $225.00 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 ethnic origin to all the rights, privileges, programs and activities generally accorded or made available to students at the schools. Furthermore, Archdiocesan schools admit disabled students in accord with the policy on Admissions in the Archdiocese of Denver Catholic Schools Adminis-trator’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 Financial Contract

2020 - 2021 Academic School Year Evaluated Midyear for

Adherence Method of Payment:

It is the responsibility of all parents to pay their tuition on a timely basis. If your tuition is not paid by the 20th day of the month, further action will be taken. If more than one mailing address is required, a $20 charge will be added for each additional address.

St. Mary Catholic Education Foundation Greeley endowment fund is available for qualifying families. If you are applying to the endowment fund for tuition assistance, applications must be returned to Susan Benke, Business Manager, by April 30, 2020. All applications must include copies of your income tax return.

If you receive assistance or any other discount, fundraising and volunteerism requirements must be met. Status of both factors will be evaluated mid-year.

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.

Fees: All Non Refundable Registration Fee: Book Rental & Supplies:

$225.00 per family, due at registration $150.00 per child, due August 1, 2020

Tuition: Kindergarten through Eighth Grade _____*Catholic Families (In “Good Standing” with your parish) Initial First Child Second Child Third Child Fourth Child

$4,450.00 $4,250.00 $4,050.00 Free *If you are not recognized as an active, contributing member of your parish, you will becharged the Non-Catholic/No Parish Affiliation rate

_____*Non-Catholic or no Parish Affiliation Initial First Child Second Child Third Child Fourth Child

$6,100.00 $5,900.00 $5,700.00 Free

*Catholics in “Good Standing”: It is the responsibility of all Catholic parents to be in “Good Standing” within their parish.To be a Catholic in Good Standing you must do the following:

• Be registered at your parish• Attend Mass on a regular basis• Give of your treasure to your parish by check or envelope• Give of your time to your parish in a volunteer capacity

(You must have the parish affiliation form signed to receive the Catholic rate)

1 of 2

Initial

Over

Family Name: ________________

_____Initial

Initial

______

I(We), ________________ _____________________, as the parent/guardian of _________________________, __________________________, __________________________, __________________________,at St. Mary Catholic School, choose the following payment option:

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

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

Payment made monthly on the 10th or 20th of the month.

______

______Initial

St. Mary Catholic School

Fundraising Goals

In order to keep tuition affordable, all parents are asked to participate in the school fundraisers. Tuition will have to be raised to meet the financial needs of the school if fundraising goals are not met. The ideal amount needed per family remains $976.

- Purchasing $5,000 of Script over the year, will bring $250 donation to the school. You can solicit help from your friends and family to help you raise this scrip amount. Scrip is available throughout the school year in the parish office Monday–Friday and through the Wednesday Communication Envelope. It may also be purchased in the parish office Monday-Thursday during the summer months. You may start purchasing scrip for the 2020-2021 academic school year on June 10, 2020.

- This year’s fundraising goal is $726, plus $250 in scrip donation, making the total fundraisingamount $976. You can reach your fundraising goal by participating in various fundraising events throughout the school year. Fundraisers are a part of St. Mary Catholic School. The school relies on participation to fund our school.

All parents are encouraged to give of their time to help with school activities, committees and other events.

Father/Guardian Name (Printed)

Mother/Guardian Signature Date

* This section, if applicable, will be completed upon approval of scholarship awarded.

Scholarship Addendum (Based on Need)

Tuition Amount $_________________

Scholarship Awarded $_________________

New Tuition Amount $ _________________

Father/Guardian Signature Mother/Guardian Signature Date

2 of 2

Pastor

Principal Business Manager

Date

Date

Mother/Guardian Name (Printed)

Father/Guardian Signature Date

Date

Date

St. Mary Catholic School

Health Questionnaire 2019-2020 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 _______________________________________

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.

Date of Birth ___________________ Male Female

St. Mary Catholic School Permission Sign-Off

2020-2021 Academic School Year

Child’s Name_______________________________ Child’s Name _______________________________ Child’s Name ______________________________ Child’s Name _______________________________ Please read the below items and indicate your permission for each item. Please be sure to initial after each item for which you give permission and sign the bottom of this sheet.

1. When accompanied by the teacher and class, my child has permission to walk to the Centennial ParkLibrary. (Located across the street on 23rd Avenue.) ................................................. (initial)

2. When accompanied by the physical education teacher and class, my child has permission to walk tothe Centennial Park Tennis Courts. (Located across the street on 23rd Avenue.) ...... (initial)

3. When accompanied by the physical education teacher and class, my child has permission to run/jogaround the outside perimeters of the church and/or school as a part of physical education class.Only Middle School students participate in this activity. ........................................ (initial)

Dismissal Information 2020-2021 Academic School Year

I give permission for my child/children to get home in the following ways: Name: Grade: Picked up Walk Ride bike

____________________________________ ______

____________________________________ ______

____________________________________ ______

____________________________________ ______

Parent/Guardian Signature Date

St. Mary Catholic School Permission 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 State Zip Code _____________________________________ Home, Cell and/or Work Phone Numbers

Child/Children Information

_____________________________________ Print Child’s Name Grade

_____________________________________ Print Child’s Name Grade

_____________________________________ Print Child’s Name Grade

____________________________________ 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 School 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, City, State, Zip Phone ______________________________________ __________________________________________ ___________________ Child’s Dentist Address, City, State, Zip 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, City, State, Zip Phone

__________________________ ______________ Address Work Phone __________________________ ______________

______________________________________________________________________

______________________________________________________________________Work Address, City, State Zip

Employer

Parent Signature Date

Cell Phone

PLEASE KEEP THIS FIRST PAGE FOR YOUR INFORMATION

St. Mary Catholic School 2020 - 2021 School Year

ST. MARY CATHOLIC SCHOOL CARE PROGRAM

HOURS OF OPERATION: Morning -----------7:00 AM – 8:00 AM NO AFTERNOON CARE ON Noon Dismissal DAYS Afternoon----------3:30 PM – 5:30 PM

Morning Care will be held in the school library. Aftern oon Care will be in classroom 2 & 3 in the parish center until 4:30pm. After 4:30pm, after Care will be in the school library. In case you need to

call between 4:00pm and 4:30pm the number is 970-353-8100, then press 252; and after 4:30pm the number is 970-353-8100, then press 207.

COST FOR EXTENDED CARE:

Rates are based on hourly or half hour fees. Rates are $6.00/ hour or $3.00/half hour.

****THERE IS A $10.00 LATE FEE FOR C HILDREN PICKED UP AFTER 5:30 PM.

BILLING INFORMATION: Billing for St. Mary Care Program will be sent out every two weeks in the Wednesday communication envelope. Please return your payment in the Wednesday envelope to the school office. The payment must be paid no later than Friday of the mailing week. A LATE FEE OF $5.00 WILL BE ASSESSED FOR PAYMENT AFTER FRIDAY OF THE BILLING CYCLE.

SNACK: An afternoon snack will be provided.

ACTIVITIES: Daily activities include snack, reading, homework time, table games and outside activities.

REGISTRATION:

Before a child can attend this program, an application must be completed in its entirety.

OTHER QUESTIONS: Please call Terri Tafoya, Program Director at 970-353-8100, extension 227.

St. Mary School does not discriminate on the basis of race, age, ha ndicap, color, national or ethnic origin in the administration of educational policies, employment practices, scholarship and loan programs or athletic or other school administered programs.

St. Mary Catholic School ST. MARY CARE PROGRAM

SMCP APPLICATION FOR ENROLLMENT 2020 - 2021 SCHOOL YEAR

Student’s Name ___________________________ ______________________ Grade Birthdate Student Name

Student’s Name ___________________________ ______________________ Grade Birthdate Student Name

Student’s Name ___________________________ ______________________ Student Name Grade Birthdate

Student’s Name ___________________________________________________________________________ Student Name Grade Birthdate

Father/Guardian __________________________________________________

Address / Zip Code _______________________________________________________________________

Child/Children live(s) with: ________________________________________

According to Colorado State Law only the people listed below will be allowed to pick up your child/children unless otherwise directed by the parent by way of verbal notice. Photo ID may be requested.

The people listed below are emergency contacts authorized to pick up my children

1. ___________________________ ______________ _____________ ______________ ______________

2.

3.

Relationship Home Phone

Please indicate below if there is any person(s) NOT ALLOWED to pick up your child.

_________________________________________________________________________________________

_________________________________________________________________________________________

Name

___________________________Name

___________________________Name

______________ _____________ ______________ ______________

______________ _____________ ______________ ______________

Work Phone Cell Phone

Relationship

Relationship

Home Phone

Home Phone

Work Phone

Work Phone

Cell Phone

Cell Phone

Mother/Guardian __________________________________________________________

Address / Zip Code _______________________________________________________________________

SIGNATURE____________________________________DATE__________________________

AUTHORIZATION FOR EMERGENCY MEDICAL CARE:

I, _________________________________ hereby give my permission for St. Mary Catholic School Staff to call for medical or make surgical decisions for my child/children ______________________ ____________________, _______________________, or ______________________ 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.

* PERMISSION FOR PARTICIPATION IN ACTIVITIES:I give permission for my child/children to participate in all program activities except for the following:

*

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

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/PG for any of these items. Yes No Except following: _____________________________________________

Parent/Guardian _________________________________ Date ______________________________

_____________________________________________________________________________________

=========================================================================================

=========================================================================================

========================================================================================

St. Mary Catholic School ST. MARY CARE PROGRAM ANNUAL AUTHORIZATION FORM

CARE PAGE 2 OF 3

*

ST. MARY CATHOLIC SCHOOL 2351 22nd Avenue, Greeley, CO 80631 • 970-353-8100 • Fax 970-353-8700

"Thechild grew and became strong,filled with wisdom; and the favor of God was upon him" (Lk 2:40)

Before/After Care Financial

Contract 2020- 2021 School Year

Parent/Guardian Signature Date

Family Name _________________________________

St. Mary Catholic School offers a Before and After Care program for the convenience of our students and parents. Before Care is available from 7:00am to 8:00am and the After Care program is available from 3:30pm to 5:30pm. The current cost of the program is $6.00 per hour per child prorated. There is also a late charge of $10 for children picked up after 5:30pm. Care is billed bi-weekly and due upon receipt of invoice.

By signing this form you acknowledge that it is your responsibility to pay the Care bill on a timely basis. If for any reason you owe money for Care at the end of the school year, St. Mary will actively collect the debt up to and including turning your account over to collections.

CARE PAGE 3 OF 3

The family out-of-parish affiliation form is used to determine if a family/parent/guardian qualifies for the affiliated tuition rate as a registered member of their parish. On an annual

basis, the family out-of-parish affiliation form must be submitted by the family and signed by their pastor in order for the family/parent/guardian to receive the affiliated tuition rate.

Parish affiliation is defined as families who are registered members of Archdiocese of Denver parishes and whose children are enrolled in an archdiocesan elementary school not in

their parish of membership for Kindergarten or a higher grade, or one of the two archdiocesan-operated high schools. These families are eligible to receive the affiliated Catholic tui-

tion rate if they meet the following criteria:

1) The family has been registered in the parish for at least six (6) months.

2) The family verifiably contributes, according to their means, on a regular basis to the financial support of the parish.

3) The family attends weekend Mass regularly and is involved in the activities, organizations or programs at the parish.

Name

Address

Phone

Student Name Grade

Student Name Grade

Student Name Grade

Student Name Grade

I/We have read and understand the parish affiliation policy and criteria used to determine parish affiliation and qualifying for the affiliated tuition rate. I/We understand that the infor-

mation provided is subject to verification. If it is determined that I/we do not qualify, I/we will be notified and agree that the tuition rate will be increased to the unaffiliated rate for the

school year. I/We understand that all paperwork and associated confirmation of parish affiliation must be on file with the school on or before September 16.

Parent/Guardian Signature ___________________________________________________________________________ Date ______________________________________

This family is eligible to receive the affiliated tuition rate at St. Mary Catholic School.

Pastor Sign ature __________________________________________ Date: ________________________________

To be completed by Parish Office on an annual basis

To be completed by Family/Parent/Guardian on an annual basis

I/We are registered parishioners at ___________________________________________________________ located in _______________________________________________.

If approved by the pastor, students in grades

Kindergarten—12 qualify as Out-of-Parish

Affiliated Students (OPAS)

FAMILY OUT-OF-PARISH AFFILIATION

St. Mary Catholic School

2020 - 2021 Academic School Year

2351 22nd Ave. Greeley, CO 80631Fax: 970-353-8700

It is the responsibility of the local-level principal, pastor and business manager to determine the internal process to track and validate “in-parish” affiliation. The Family Out-of-Parish

Affiliation form is used to track and validate out-of-parish family affiliation only. AoDCS, OCS February 10, 2014

This family is not eligible to receive the affiliated tuition rate at St. Mary Catholic School.

Comments ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ST. MARY PARISH AFFILIATION CONFIRMATION

St. Mary Catholic School 2020 - 2021 Academic School Year

School: St. Mary Catholic School, 2351 22nd Ave, Greeley, CO 80631 (970) 353-8100

FAX: (970) 353-8700

To be completed by Family/Parent/Guardian on an annual basis

Student Name(s): Grade :

1. ________________________________________________

2. ________________________________________________

3. ________________________________________________

4. ________________________________________________

______________

______________

______________

______________

Parents’ or Guardians’ Information:

Name: ________________________________________________________________Address: ______________________________________________________________ Telephone: ___________________________

To be completed by Parish Office on an annual basis

This family is eligible to receive the affiliated tuition rate at St. Mary Catholic School.

This family is not eligible to receive the affiliated tuition rate at St. Mary Catholic School.

____________________________ Pastorôs Signature Date

ST. MARY CATHOLIC SCHOOL 2351 22nd Avenue, Greeley, CO 80631 • 970-353-8100 • Fax 970-353-8700

"The child grew and became strong, filled with wisdom; and the favor of God was upon him" (Lk 2:40)

REQUEST FOR RECORDS

Name of School

Mailing and/or Street Address

City State

Student Name

Special information authorized to release:

__ Regular Education Records

Grade

Attendance Records

Test Scores

Health Records

Immunization Records

Zip Code

Birthdate Grade

__ Special Education Records

__ Social/Medical Records

__ Psychological Records

Education Records

__ Speech/Language Records

__ Audiological Records

Other ____________ _

The information will be used in compliance with the Family Educational Rights and Privacy Act and the

Colorado Open Records Law.

St. Mary Catholic School

2351 22nd Avenue

Greeley, CO 80631

I hereby authorize you to release information regarding the above named student/students to

St. Mary Catholic School.

Signature of Parent/Legal Guardian Date