Registration Fee of $275.00 per family non refundable. Make checks

KINDERGARTEN REGISTRATION FORM 2015-2016
Family Name
Father’s First Name
or other Guardian
Mother’s First Name
or other Guardian
Address
City, State
Child’s Name
Social Security Number
Name child prefers to be called
E-mail Address
Zip
Telephone Number
Date of Birth
__________________________________
Child Lives with: (Complete below)
Both Parents ___________
Mother Only ___________
Father Only ___________
Shared Custody ________
Guardian _____________
Registered Member of
____________Parish
Public School District
Non-Parishioner_____
Name of Public School_______________________
Dependent on Bus Transportation? ______
***Only Finneytown & Winton Woods Transportation will bus both ways for
AM Kindergarten.***
Please note your first and second choices for kindergarten:
AM (9:00 – 11:45) ______
ALL DAY (9:00 AM – 3:30 PM) ______
Registration Fee of $275.00 per family non refundable.
Make checks payable to JPII
BIRTH CERTIFICATE and REGISTRATION FEE MUST ACCOMPANY THIS REGISTRATION FORM.
***************************************************************************************************
For Office Use Only:
Check # and date
JOHN PAUL II CATHOLIC SCHOOL
NEW STUDENT PROFILE
9375 Winton Road, Cincinnati, Ohio 45231
Please print ~one per child~
STUDENT INFORMATION:
Last Name
Date and Place of Birth
First Name
Religion
Likes to be Called
Baptism Date
Church
Middle Name
First Eucharist Date
Church
Child's Address
Reconciliation Date
Church
City
Confirmation Date
Church
State/Zip
Grade for 2015/2016
Phone Number
Child's Social Security Number
Public School District
Enrollment Date
Previous School Attended
Registered Member of
Parish
Non Parishioner
PARENT INFORMATION:
Child lives with:
Both Parents
Mother Only
Father Only
Shared Custody
Guardian
Marital Status:
Married
Separated
Divorced
Single
CIRCLE ONE:
CIRCLE ONE:
*Father/Step Father/Guardian Information
*Mother/Step Mother/Guardian Information
Name
Name
Religion
Religion
Occupation
Occupation
Business Phone
Business Phone

IF THERE ARE ANY EXTENUATING CIRCUMSTANCES, SUCH AS SHARED CUSTODY, PLEASE
PROVIDE DOCUMENTATION REGARDING ALL CUSTODIAL ISSUES.
 Below please list Public School that student would attend if not attending
JPIICS:
__________________________________________________________
John Paul II Catholic School
9375 Winton Road
Cincinnati, OH 45231
513-521-0860
PROBATION FOR NEW OR TRANSFER STUDENTS
As a condition for enrollment of any student new to John Paul II Catholic School, the
student and the parent(s)/guardian(s) agree that the student will be on a probationary
status during the first semester of attendance.
During the probationary period, the student will
 Achieve appropriate academic progress
 Comply with the discipline policy of the school
 Attend school regularly and promptly
 Meet all financial obligations
If necessary, at the conclusion of the probationary period, a meeting may be held with the
parent(s)/guardian(s). At that time a decision will be made regarding the enrollment
status of the student. The decision made by the administration is binding and must be
accepted by the parent(s)/guardian(s) on behalf of the student.
I have read and agree to the conditions outlined in the probationary period for my/our
child. I agree to pay all fees at the time of registration and make tuition payments in
accordance with the parish and/or school policy.
__________________________
Parent(s)/Guardian(s) Signature
__________________________
Principal
__________________________
Date
________________________________
Student Name
ARCHDIOCESE OF CINCINNATI
REQUEST FOR RELEASE OR TRANSFER OF SCHOOL RECORDS
This form is provided for the purpose of obtaining or releasing a student’s records. By
signing this release, a parent, guardian, or the student involved who is over 18 years of
age, will expedite the transfer of records to another school for enrollment in that school.
Name of previous school attended
Address
City
State
Zip
I,
, (Parent/Guardian/Adult Student) do
hereby give my permission for pertinent school records of:
Name
Grade
to be released to:
John Paul II Catholic School
______
Name of new school
9375 Winton Road
Address
Cincinnati, OH
45231
City
State
Zip
By signing this request for transfer, I relieve the school, which the above named student
was attending, of the responsibility of notifying me that the records are being
transferred. This authorized transfer of all school records (as defined by P.L. 93-380
and any amendments thereto).
Parent/Guardian/Adult Pupil
Date
Leanora Roach
Principal
________
Date
Student’s Name
Current Grade
Grade for 2015/2016
Please answer the following questions concerning the child you are registering so we may fully meet and
understand his/her needs.
1.) Have you been informed that your child has any academic or behavioral concerns? If so, please
explain. You may use the back of this sheet if necessary.
2.) Please check any services your child has received or is currently receiving:
At School
L.D. Tutoring
Private
Speech
Speech
Tutoring (Subject
Supportive Math
Physical Therapy
Psychological Services
Occupational Therapy
)
3.) Does your child have any special needs that require classroom adaptations? If so, please explain.
4.) Does your child have any medical conditions which require special adaptations? List any medications
your child takes on a regular basis:
5.) Are there any physical limitations which require special adaptations?
6.) Have you been advised as a parent/guardian about any of the following situations
affecting your child’s future schooling:
He/she is not recommended for Kindergarten due to developmental or academic readiness.
He/she may be “placed” rather than promoted to the next grade.
He/she may be retained in current grade.
I’ve not been advised that any of the above is a possibility.
7.) Has your child ever been:
suspended
Signature/Relationship
expelled
asked not to return (please explain)
Date
A Scholarship Fund has been set up in memory of Kathleen Hinkel, a
former Kindergarten teacher at our school. At the request of her family, a
memorial fund has been established to help families who need assistance in
paying for Kindergarten tuition at John Paul II Catholic School. This will be a
partial scholarship and will be paid directly to JPII. Parents are responsible for
the remaining tuition and fees.
Questions:
1. Who is eligible?
Eligibility is based on family need. If you meet the income eligibility
requirements and have a child entering Kindergarten, you qualify for
the selection process.
2. How do I apply?
Complete application on back. All information is confidential.
3. Who administers the Scholarship Fund?
The Fund is administered by a committee from JPII.
INCOME ELIGIBILITY GUIDELINES FOR 2015-2016
MAXIMUM INCOME BASED ON 2014
FAMILY SIZE
ADJUSTED GROSS INCOME
2
$28,000
3
$36,500
4
$42,500
5
$52,500
(FOR EACH ADDITIONAL CHILD ADD $8,000)
*FAMILY SIZE INCLUDES EVERY PERSON LIVING AT THE HOME ADDRESS
PARENT/GUARDIAN NAME ______________________________________
CHILD’S FULL NAME ___________________________________________
CITY, STATE, ZIP _____________________________________________
DATE OF BIRTH ______________________________________________
HOME PHONE ________________________________________________
WORK PHONE ________________________________________________
TELL US ABOUT ANY SPECIAL CIRCUMSTANCES YOU MAY HAVE:
*APPLICATION DEADLINE – April 13, 2015