501 E. 2nd St., Casa Grande, AZ 85222 (520) 836-7247 Fax: (520) 836-7289 St. Anthony of Padua Catholic School Office Use Only: 2014-2015 REGISTRATION FORM Entry Date___________ Entry Gr. Lvl._____ Teacher ______________________ Church Envelope Number _______ Please print using a black or blue pen STUDENT INFORMATION: Last Name First Name Middle Name Date of Birth Mailing Address City Zip Residence Address City Zip Home Phone Email Address Where do you attend religious services? Baptismal Date Place First Communion Date Place Reconciliation Date Place Confirmation Date Place Age as of August 1, 2015 M/F Grade Entering Has child ever attended our school? If yes, specify dates and grades. Sibling attending this school: Name(s) and Grade(s) Ethnicity (Please Circle One): Asian Black Hispanic Native American White Mixed Ethnicity: Educational History: Has student ever been enrolled in programs such as Special Education, Speech/Language, Title 1, Gifted, Bilingual, etc? [] yes []no If yes, please specify the program- PARENT/GUARDIAN INFORMATION: (the person(s) with whom the student resides) Name Rel ationship to student Employer Work Phone Name Cel l Phone Religion Relationship to student Employer Work Phone Cel l Phone Religion HOME LANGUAGE SURVEY: (the questions below are in compliance with R7-2-306 from Board Rules) What is the language that the student first acquired? What is the language most often spoken by the student? What is the primary language used in the home regardless of the language spoken by the student? PARENT CERTIFICATION: I certify that I am a legal guardian of this child, and that the information provided is true and correct. Parent/Guardian Signature: Date: PARENT COMMITMENT AGREEMENT:  I commit to making tuition payments by the 10th of every month. In addition, I commit to volunteering at least 40 hours to St. Anthony of Padua Catholic School over the coming school year. For each volunteer hour that I cannot meet, my account will be charged $20 per volunteer hour.  I understand that monthly payments will not be pro-rated if I choose to withdraw my student(s). I will pay the entire month’s tuition, regardless of how many days my child(ren) was in attendance during the month of the withdrawal.  If my child is transferring from another school, I will provide a copy of my child’s most recent Report Card and recent Standardized Test Scores. Parents are required to submit Birth Certificate, Baptism Certificate and Updated Immunization Record at the time of registration. Copies can be made in the front office. All families are required to complete a FAIR application regardless of income. I fully understand and will abide by the statements above and I have received a copy of FERPA. Parent/Guardian Signature: Date: