Registration 2021 - 2022 - St. Elizabeth Ann Seton

Family Name REQUIRED Please fill out this field. Please enter valid data.

Mother's name REQUIRED Please fill out this field. Please enter valid data.

Father's name REQUIRED Please fill out this field. Please enter valid data.

Primary email address REQUIRED Please fill out this field. Please enter an email address.

Secondary email address Please enter valid data.

Primary phone REQUIRED Please fill out this field. Please enter valid data.

Primary phone Mom's cell Dad's cell Home phone

Secondary phone REQUIRED Please fill out this field. Please enter valid data.

Secondary phone Mom's cell Dad's cell Home phone

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

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

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

Emergency contact - Name REQUIRED Please fill out this field. Please enter valid data.

Emergency contact - Phone REQUIRED Please fill out this field. Please enter valid data.

How many children are you enrolling? REQUIRED Please fill out this field.

Student 1

Student's Name REQUIRED Please fill out this field. Please enter valid data.
Any allergies or medical conditions? REQUIRED Please fill out this field. Please enter valid data.
Grade registering for REQUIRED Please fill out this field.
First choice class day / time REQUIRED Please fill out this field.
Second choice class day / time REQUIRED Please fill out this field.
Media Release: For your protection and privacy, we at St. Elizabeth Ann Seton Parish ask your permission to potentially use your child's picture in publications and/or bulletin boards, website, social media, and newspaper. Names will not be posted. REQUIRED Yes, I give my permission to use my child's picture on the parish / diocesan website / social media, in local newspapers, and/or in parish / diocesan publications / bulletin boards. No, do not use my child's picture on the church publications Please fill out this field.

Student 2

Student's Name Please enter valid data.
Any allergies or medical conditions? Please enter valid data.
Grade registering for
First choice class day / time
Second choice class day / time
Media Release: For your protection and privacy, we at St. Elizabeth Ann Seton Parish ask your permission to potentially use your child's picture in publications and/or bulletin boards, website, social media, and newspaper. Names will not be posted. Yes, I give my permission to use my child's picture on the parish / diocesan website / social media, in local newspapers, and/or in parish / diocesan publications / bulletin boards. No, do not use my child's picture on the church publications

Student 3

Student's Name Please enter valid data.
Any allergies or medical conditions? Please enter valid data.
Grade registering for
First choice class day / time
Second choice class day / time
Media Release: For your protection and privacy, we at St. Elizabeth Ann Seton Parish ask your permission to potentially use your child's picture in publications and/or bulletin boards, website, social media, and newspaper. Names will not be posted. Yes, I give my permission to use my child's picture on the parish / diocesan website / social media, in local newspapers, and/or in parish / diocesan publications / bulletin boards. No, do not use my child's picture on the church publications

Would you like to volunteer? REQUIRED Teacher (exempt from tuition) Aide (discounted tuition) Substitute Not at this time Please fill out this field.

Tuition: 1 child - $150; 2 or more children - $300
Teachers: $0

Payment REQUIRED 150 – 1 student 300 – 2 or more students 0 – Teacher Please fill out this field.

St. Elizabeth Ann Seton Church