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MARY OF LOURDES SCHOOL
Non Parish Kindergarten Registration Form/Tuition Agreement
Please complete this registration form to provide current information for the 2015-2016 school year.
PARENT(S) NAME:
ADDRESS:
HOME PHONE#
Religious Denomination:
EMERGENCY CONTACT:
PHONE:
* PLEASE INCLUDE KINDERGARTEN STUDENT ON FAMILY REGISTRATION AS WELL.
FATHER’S INFO.
MOTHER’S INFO.
Parent Occupation:
Place of Employment:
Employment Phone:
Parent Cell Phone:
Parent e-mail address:
Parent Religion:
Maiden Name:
STATUS OF PARENTS:
Single
Married
Divorced
Separated
Widowed
CHILD/CHILDREN LIVE WITH:
* List Child(ren) who will attend Mary of Lourdes Kindergarten Program:
Name (First, Middle, Last)
Birthdate
Gender (circle one)
K’ Program (circle one)
__
M
F
4-day transition 2nd sem. 5-day
_____________
__
M
F
4-day transition 2nd sem. 5-day
ETHNICITY:
Each family is asked to assist with the volunteering efforts of the school by giving of their time and talent.
Base tuition for Kindergarten program: $2,650
*In addition, each family will be expected to donate 15 credits of volunteer time and talent in service to the
children of the school, or be assessed $17 for each credit not completed. This is a 15 credit per family incentive,
not per child.
Examples:
0 earned credits: 15 x $17 = $255 + $2650 (1st child tuition) = $2,905
5 earned credits: 10 x $17 = $170 + $2650 = $2,820
15 earned credits: 0 x $17 = $0 + $2650 = $2,650
Number of Total Registered Children at MOL
I have enclosed a $265.00 deposit per kindergarten family registered. This kindergarten deposit will be
applied to tuition which is 10% of tuition (see above) for the 2015-2016 school year.
I agree to pay the remaining tuition ($2,395) according to the plan checked below:
In full in September & fulfill 15 volunteer credits during the school year.
Tuition Management plan (direct deposit) which consists of ten monthly, four quarterly OR two payment
installments. (Will be put in Fall Open House packets)
_______ Pay the full tuition of $2, 905 without the 15 volunteer credits during the school year.
Would like to discuss payment plan with administrator (632-6742)
Policy 501.1 Registration or enrollment at MOL School will be held the first two weeks of March.
Acceptance by MOL School of a child’s registration for the succeeding year will be dependent upon
fulfillment of the current year’s tuition agreement.
Signature of Parent/Guardian
Date
C:\Users\MOLES\Documents\my docs\Registration packets\2015-16\Non-Parish K Reg. '15.doc