New Family or Re-Enrollment Contract Form

Full Name of Parent or Guardian REQUIRED Please fill out this field. Please enter valid data.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter valid data.

E-mail Address REQUIRED Please fill out this field. Please enter valid data.

Employer REQUIRED Please fill out this field. Please enter valid data.

Occupation REQUIRED Please fill out this field. Please enter valid data.

Spouse's Employer Please enter valid data.

Spouse's Occupation Please enter valid data.

Name of Person Financially Responsible Please enter valid data.

Street Address (If different than parent/guardian) Please enter valid data.

City Please enter valid data.

State Please enter valid data.

Zip Please enter valid data.

Email Address Please enter valid data.

Phone Number Please enter valid data.

Student's First Name REQUIRED Please fill out this field. Please enter valid data.

Student's Last Name REQUIRED Please fill out this field. Please enter valid data.

Program Attending REQUIRED Please fill out this field.

Student's First Name Please enter valid data.

Student's Last Name Please enter valid data.

Program Attending

Payment Plan Selection REQUIRED Pay in Full (Due 8/14/20) 9 Monthly Payments ( August 2020 to April 2021) My family has applied for BLOCS Tuition Assistance Please fill out this field.

Start Date REQUIRED Please fill out this field. Please enter valid data.

Are you interested in Before School Care (8:00 am to 9:00 am) REQUIRED Yes No Please fill out this field.

If answered Yes, select the days will you need morning care. Monday Tuesday Wednesday Thursday Friday As needed basis

Parent / Guardian Name. By printing your name in this block, you are signing Agnus Dei Academy Enrollment Contract and agree to assume the financial obligations for tuition and fees and to enroll with FACTS Management Company REQUIRED Please fill out this field. Please enter valid data.

Date REQUIRED Please fill out this field. Please enter valid data.

Saint Mary Catholic School

Learning Today, Leading Tomorrow

New Family or Re-Enrollment Contract Form