On-line Registration 2007 – 2008 School Year 

                                                         1700 8th Street South Brookings, SD 57006

                                                                              (605) 692-6796 

Student’s Legal Name

_____________________________________________________                                                            First                                         Last                                         Middle

 Student’s Preferred First Name ___________________             Phone Number _________________

 Student’s Address

______________________________________________________________                                                      Street                                                   City                         State                        Zip     

Date of Birth ___________________  Place of Birth ________________       Gender _______

 Ethnicity (circle)            Asian     Black     Hispanic     Indian     White     Other _________

 Father’s Name ________________________            Mother’s Name ________________________

Home Address ________________________            Home Address _________________________

Home Phone __________________________           Home Phone ___________________________

Father’s Employer ______________________           Mother’s Employer _____________________

Business Phone ________________________            Business Phone ________________________

Denomination _________________________            Denomination _________________________

Parish/Congregation ____________________            Parish/Congregation _____________________ 

Child’s Siblings

     ___________________     Age ______                 ___________________     Age _______

     ___________________     Age ______                 ___________________     Age _______

 Class Preference & Fee Schedule 

0       3 Year Old Session     Tuesday/Thursday Morning      8:30 – 11:15 AM     $70.00 Monthly

         Recommended for children who will turn 4 in March 2008-August 2008

0       3/4 Year Old Session     Tuesday/Thursday Afternoon    12:45 – 3:30 PM     $70.00 Monthly

Recommended for children who will turn 4 in September 2007-February 2008

 

0       4/5 Year Old Session   Monday/Wednesday/Friday Morning     8:30 – 11:15 AM   $80.00 Monthly

0       4/5 Year Old Session   Monday/Wednesday/Friday Afternoon   12:45 – 3:30 PM   $80.00 Monthly

 

0       Registration Fee Per Child – Non-Refundable (Deducted from First Monthly Fee)     $25.00

0       I would like to donate $___.__ for a scholarship fund.

0       I am interested in applying for scholarship based on a family need.  (Further paperwork will be required.)

 

Please enclose the Registration Fee with this registration to insure enrollment for the Fall of 2007 and return by       September 1st to Parish Office at 1700 8th Street South in Brookings

 

Parent/Guardian Signature __________________________________            Date _________________