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St. Amelia School

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Online Registration
2022-2023

Please complete the Application for Enrollment form below, this is the first step in the enrollment process for your child. Please fill out a separate application for each student registering.

Required fields marked with an asterisk *

Which best describes your child?

Returning Student

New Student (Current Family)

New Student (New Family)

Student Information:

First Name

Last Name

Birthday

Does student have and IEP or 504 plan?

IEP

504

None

Student Gender

Male

Female

Street Address

City

State

Zip Code

What grade is student entering for the 2022-2023 school year?

Home District of Student

What Public School would your child attend if not St. Amelia School:

Student Race

Am. Indian / Alaskan

Asian

Black / African American

Pac. Is / Native Hawaiian

White

Is student Hispanic?

Yes

No

Please select which option applies best:

Family Household

Lives with Relatives / Friends

Foreign Exchange Student

Other (shelter, motel, hotel, or car)

Religious Affiliation of student

Catholic Parish Affiliation of Student

Date and Location Of Baptism

St. Amelia School Photo/Video Release:

Has permission to be included in school photos and videos

Does not have permission to be included in school photos and videos

Examples of what we use photos and videos for include but are not limited to: social media posts, marketing material, and local newspapers articles.

Parent Information:

Parent / Guardian #1

Prefix

Mr.

Mrs.

Miss

Ms.

First Name

Email

Religious Affiliation

Last Name

Maiden Name

Street Address

City

Zip Code

State

Mobile Phone

Work Phone

Occupation

I have financial responsibility for this child

Yes

No

I have legal custody

Yes

No

Are you a graduate of St. Amelia School?

Yes

No

Is this a divorced/seperated family hoursehold?

Yes

No

Relationship to child

if other please explain

If yes, what year did you graduate?

Marital status of parents:

Married

Separated

Divorced

Single

Parent/ Guardian #1 is a single parent or has sole reponsibility for student

Parent / Guardian #2

Prefix

Mr.

Mrs.

Miss

Ms.

First Name

Last Name

Street Address

City

Zip Code

Mobile Phone

Email

State

Work Phone

Maiden Name

Occupation

I have financial responsibility for this child

Yes

No

I have legal custody

Yes

No

Are you a graduate of St. Amelia School?

Yes

No

Is this a divorced/seperated family hoursehold?

Yes

No

Relationship to child

if other please explain

If yes, what year did you graduate?

Marital status of parents:

Married

Separated

Divorced

Single

Emergency Contact Information:

(Emergency Contact should be person(s) other than parent(s) listed above)

Emergency Contact 1

First Name

Mobile Phone

In the event of an emergency, Emergency Contact 2 may pickup my child.

Last Name

Alternate Phone

Relationship

Emergency Contact 2

First Name

Mobile Phone

Last Name

Alternate Phone

In the event of an emergency, Emergency Contact 2 may pickup my child.

Relationship

Physician's Information

Physician's Information

Physician Street Address

Physician City

Physician State

Physician Zip code

Physician Phone

The following person(s) may NOT pick up my child:

By signing below, I am agreeing that the information provided above is accurate.

Select a date

Confirmation Email

New families, please remember that your application is not considered complete until we have received your child(ren)'s birth certificate and registration fee. Returning families will be charged the registration fee on their FACTS account.

After pressing 'Submit' you will be given the option to pay online, or you can pay in person at the school's main office.

A confirmation email will be sent shortly after submission to verify we have received your application.

Attach pictures of any documentation you would like to include at this time. Documents can also be brought to the main office or emailed at anytime prior to the first day of school

Upload File

Upload supported file (Max 15MB)

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