St. Jerome Regional School Registration

Student Information

Please fill out all the below information based on the child.

First Name *

Middle Name

Last Name *

Gender *

Birth Date * +

Registering for Grade: *

Place of Birth

Ethnicity *

Primary Language *

School/ Preschool Previously Attended *

School District in which you pay taxes *

Busing Needed *

Yes

No

Religion *

Catholic

Non-Catholic (Please List) Non-Catholic (Please List)

Sacraments Received (if applicable)

Baptism

First Eucharist

Confirmation

Parish Affiliation (if none, please write n/a) *

Does student have any known allergies or medical conditions? *

No

Yes

If yes, please list:

Does Student have a IEP or Service Plan? *

No

Yes

Lives with: *

Is there a custody agreement? *

No

Yes

If child does not live with parents, please list the following: 1. Name of guardian 2. Address & Telephone 3.Guardian's Religion 4. Guardian's Place of Employment

Please click the following link for our request for records form. This is required for any students enrolling in grades 1 through 8. This form can be emailed directly to ldaukshus@sjrschool.com.

Request for Records

Parent Information

If a parent is deceased please type "deceased" in the required boxes for that parent. Thank you.

Father

First Name *

Last Name *

Occupation *

Place of Employment *

City/State/Country Born

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Mother

First Name *

Last Name *

Occupation *

Place of Employment *

City/State/Country Born *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Thank you for starting your child's enrollment process here at St. Jerome Regional School! Please note: all transferring students require a review of transcripts by our principal before acceptance to SJRS. Once the review is made, you will be contacted directly by our Director of Advancement. In addition, the nonrefundable registration fee of $150 per child is required to complete the enrollment application at this time. Payments can be check, cash, money order or via PayPal.

Because of the possible restrictions for next year, a preliminary waitlist will begin as soon as spots fill. If this happens, you will be notified. If we are unable to offer a spot before the start of school, we will refund the registration fee. If for any other reason, you do not decide to have your child attend SJRS, the fee is non refundable. Thank you!

Please sign to confirm that you have legal custody to enroll the applicant and that you have read and understand the above statement regarding our registration fee and enrollment process. *

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For Kindergarten Registration Only

Birth Certificate

Immunization Record

Baptism Certificate (If applicable)