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Registration

Family Information

Father's Information

Name:
Religion:
Place of Birth:
Occupation:
Work Email:
Personal Email:
Home Phone: (xxx) xxx-xxxx
Work Phone: (xxx) xxx-xxxx
Cell Phone: (xxx) xxx-xxxx
Married
Deceased
Single
Separated
Divorced
Remarried

Mother's Information

Name:
Religion:
Place of Birth:
Occupation:
Work Email:
Personal Email:
Home Phone: (xxx) xxx-xxxx
Work Phone: (xxx) xxx-xxxx
Cell Phone: (xxx) xxx-xxxx
Married
Deceased
Single
Separated
Divorced
Remarried
Maiden Name:

Mother's Address:

Address:
Apt. Number:
City:
State:
ZIP Code:


If Different from Mother's Address:

Father's Address:

Address:
Apt. Number:
City:
State:
ZIP Code:

Student 1 Information

Grade Entering:
SS. Peter & Paul Catholic School Student Last Year?: Yes No If NO:
Previous School:
School's Address:
City:
State:
ZIP Code:
Birth Certificate: Yes No


Social Security Number (Last 4 Digits): XXX-XX- (copy required on file)

Student Name

Last Name:
First Name:
Middle:
Place of Birth
City:
State:
Date of Birth:
Baptism: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Baptism Certificate on file at Ss. Peter & Paul School: Yes No



First Communion: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Communion Certificate on file at Ss. Peter & Paul School: Yes No



Confirmation: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Confirmation Certificate on file at Ss. Peter & Paul School? Yes No

Student 2 Information

Grade Entering:
SS. Peter & Paul Catholic School Student Last Year?: Yes No If NO:
Previous School:
School's Address:
City:
State:
ZIP Code:
Birth Certificate: Yes No


Social Security Number (Last 4 Digits): XXX-XX- (copy required on file)

Student Name

Last Name:
First Name:
Middle:
Place of Birth
City:
State:
Date of Birth:
Baptism: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Baptism Certificate on file at Ss. Peter & Paul School: Yes No



First Communion: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Communion Certificate on file at Ss. Peter & Paul School: Yes No



Confirmation: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Confirmation Certificate on file at Ss. Peter & Paul School? Yes No

Student 3 Information

Grade Entering:
SS. Peter & Paul Catholic School Student Last Year?: Yes No If NO:
Previous School:
School's Address:
City:
State:
ZIP Code:
Birth Certificate: Yes No


Social Security Number (Last 4 Digits): XXX-XX- (copy required on file)

Student Name

Last Name:
First Name:
Middle:
Place of Birth
City:
State:
Date of Birth:
Baptism: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Baptism Certificate on file at Ss. Peter & Paul School: Yes No



First Communion: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Communion Certificate on file at Ss. Peter & Paul School: Yes No



Confirmation: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Confirmation Certificate on file at Ss. Peter & Paul School? Yes No

Student 4 Information

Grade Entering:
SS. Peter & Paul Catholic School Student Last Year?: Yes No If NO:
Previous School:
School's Address:
City:
State:
ZIP Code:
Birth Certificate: Yes No


Social Security Number (Last 4 Digits): XXX-XX- (copy required on file)

Student Name

Last Name:
First Name:
Middle:
Place of Birth
City:
State:
Date of Birth:
Baptism: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Baptism Certificate on file at Ss. Peter & Paul School: Yes No



First Communion: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Communion Certificate on file at Ss. Peter & Paul School: Yes No



Confirmation: Yes No
If Yes:
Date:
Church:
Church Address:
City:
State:
Zip:
Copy of Confirmation Certificate on file at Ss. Peter & Paul School? Yes No

Emergency Information

Family Name:
Home Phone:
Emergency Phone:
Address:
City:
State:
Zip:

Who to call if parent cannot be reached

Name: Relation: Phone:
Name: Relation: Phone:
Name: Relation: Phone:

Early Dismissal Contact

In Case of Early Dismissal Contact Above? Yes No
Name: Relation: Phone:
Name: Relation: Phone:
Name: Relation: Phone:
Instruction we should know in case of early dismissal:

Medical Conditions

My Child has:
Asthma
Peanut Allergy
Bee Allergy
Milk Allergy
Nose Bleeds
Please List other conditions:

YOUR CHILD WILL NOT BE PERMITTED TO LEAVE Ss. PETER & PAUL SCHOOL PREMISES WITH ANYONE NOT LISTED ON THE EMERGENCY LIST UNLESS THE SCHOOL OFFICE IS PROPERLY NOTIFIED

IF YOUR CHILD NEEDS MEDICATIONS AT SCHOOL, A 'REQUEST FOR ADMINISTERING MEDICATIONS AT SCHOOL AND RELEASE FROM LIABILITY' FORM MUST BE ON FILE.

THIS FORM MAY BE REQUESTED FROM THE SCHOOL OFFICE

Signature of Parent/Guardian :
Date:

Grandparent(s) Information

Maternal

Name:
Deceased:
Address:
City:
State:
Zip:

Name:
Deceased:
Address:
City:
State:
Zip:

Paternal

Name:
Deceased:
Address:
City:
State:
Zip:

Name:
Deceased:
Address:
City:
State:
Zip:

Internet Use Policy

Ss. Peter and Paul School complies with the Diocese of Springfield's Social Media Policy ~ revised July 2012. You may access this policy either by contacting the school office or on FastDirect Links. Computers are used to support, extend, and enhance learning and instruction. Computer networks allow people to interact with many computers. The internet links computers around the world, giving Ss. Peter and Paul staff and students access to a wide variety of computer and information resources. It is the policy of Ss. Peter and Paul School that all computer resources, including the internet, are to be used in a responsible, efficient, ethical, and legal manner. The following guidelines have been developed to outline how the internet is to be used by Ss. Peter and Paul staff and students. A staff member or student's failure to use the internet in the manner described below will result in revocation of access privileges.

Acceptable Use of the Internet

The internet will only be used for instructional purposes directly related to learning goals set by the classroom teacher and the curriculum objectives established by the school.

Student Access to the Internet

All students will have access to the internet through their classroom and lab computers. These information resources will be pre-approved and reviewed by instructional faculty and staff. Students will only have email access under their teacher's direct supervision using a classroom account.

Unacceptable Uses of the Internet

The following non-inclusive list of communications or actions are examples of unacceptable uses of the internet:
  • Unauthorized searching and browsing with internet information resources.
  • Using profanity, obscenity, or other language in messages that may be offensive to others.
  • Sending messages that attack or insult others.
  • Sending messages to someone after you have been told to stop.
  • Posting personal communication without the author's consent.
  • Posting anonymous messages.
  • Posting messages with personal contact information about yourself or others.
  • Agreeing to meet with someone you have met online without your parent's approval.
  • Damaging computers, computer systems or networks, including the data of others.
  • Sharing your password with others.
  • Use of network for illegal activity including copyright law violation or other software contracts.
  • Using the network for financial or commercial gain or political lobbying.

User Rights

Your constitutional right to free speech applies to your communications on the internet. Ss. Peter and Paul School may not restrict your speech solely on the basis of a disagreement with the opinions you are expressing. However, Ss. Peter and Paul School may restrict your use on the internet if your communications are not directly related to the learning goals set by the administration or classroom teacher and the curriculum objectives established by the school.

You should expect only limited privacy in the contents of your personal files on your individual storage devices. The situation is similar to the rights you have in the privacy in your desk.

Your parents have the right at any time to request to see the contents of your personal files on your individual storage devices, including emails files.

User Responsibilities

Your access to the internet is a privilege not a right. Continued internet access is based upon compliance set out in this policy.

How you use the internet reflects upon the reputation of Ss. Peter and Paul School and shows others what kind of person you are.

Modifications of Internet Use Policy

This policy can be modified at any time in order to meet arising needs and changing conditions in the field of internet technology. Notifications to this Policy will be given to the student and appropriate staff.

Parent/Guardian Consent

I have read and understand the Ss. Peter and Paul School Internet Policy. I understand that the internet is a world-wide group of hundreds of thousands of computer networks. I know that Ss. Peter and Paul School does not control the content of these internet networks. When using the internet, I realize that students may find and read material I might consider controversial or offensive. Ss. Peter and Paul School has my permission for my child to use the internet and to participate in email projects using a classroom account. I understand that my child/ren may continue to use these resources only if the procedures in the Internet Use Policy are followed.

Parent/Guardian: Yes No

Parent/Student Consent - Grades KG-3

I have read and understand the Ss. Peter and Paul School Internet Policy. I understand that the internet is a world-wide group of hundreds of thousands of computer networks. I know that Ss. Peter and Paul School does not control the content of these internet networks. When using the internet, I realize that students may find and read material I might consider controversial or offensive. Ss. Peter and Paul School has my permission for my child to use the internet and to participate in email projects using a classroom account. I understand that my child may continue to use these resources only if the procedures in the Internet Use Policy are followed. I have discussed the Ss. Peter and Paul School Internet Policy with my child/ren and feel s/he/they understands it to the best of their ability.

Parent/Guardian: Yes No

Student Consent - Grades 4-8

I have read and understand the Ss. Peter and Paul School Internet Policy. I understand that I will no longer have internet access if I fail to follow the guidelines in this policy.

Name of Student: Yes No

Certification of Medical and Indemnity Agreement

As the parent(s) or guardian(s) of , I/we certify to Ss. Peter and Paul Catholic School and the Catholic Diocese of Springfield in Illinois the following: is covered under a medical insurance policy or health care plan, specifically:

Name of Insurer Plan:
Policy or Group Number:

I/We agree to obtain Student Accident Insurance which is offered through the school
I/We further understand that Ss. Peter and Paul Catholic School does not provide any medical insurance coverage for the Child, and that I/We assume all responsibility for payment of any medical expenses (including, but not limited to, doctors' fees, hospital charges, or any other medical or related charges) incurred by the Child due to any injury or illness that occurs while the Child is in attendance at Ss. Peter and Paul Catholic School or participating in any Ss. Peter and Paul Catholic School sponsored activity, including athletic events.
I/We hereby agree to hold harmless and indemnify Ss. Peter and Paul Catholic School and the Catholic Diocese of Springfield in Illinois including their employees, volunteers, clergy and religious, from any claims for medical expenses described above.

I/We (Parent/Guardian) have read the above Agreement and fully understand the terms and contained herein, and agree to abide by its terms.
Date:

Report of Injury, Illness and/or Operation

My child , grade:
does does not have any physical problems or illness that will prevent his/her participation in regular physical education classes.

If does is checked then:
Type of Injury, Illness or Operation
Prognosis/Treatment Date

Type of Injury, Illness or Operation
Prognosis/Treatment Date

Type of Injury, Illness or Operation
Prognosis/Treatment Date

Special Considerations

Parent/Guardian

Date

Acknowledge by Principal

Sports Permission Form

SPORTS FEES:

Single Sport: $30.00
Multiple Sports: $60.00
Family: $90.00
I/We Parent/Guardian request that my son/daughter be allowed to play the following sports:
    Volleyball
    Bowling
    Basketball
    Baseball-Softball
I/We further understand that a copy of my son/daughter's birth certificate must be on file in the school office and that my son/daughter must also have a current sports physical on file in the school office.

I/We understand that I/we must carry proof of medical insurance for my child and that a Certificate of Medical Insurance and Indemnity Agreement must be on file in the school office.

Sports fees will be collected at the time of participation in your child's first sport and are separate from tuition and registration expenses.

I/We understand that the following rules must be observed:
The child will treat their coach, assistant coaches, referees and coaches of opposing teams with respect, obedience and politeness at all times.
The child agrees to follow the code of good sportsmanship at practice and at the games.
The child agrees to be respectful and polite with fellow teammates and opposing teams.
The child agrees to be responsible for the uniform s/he is provided.
The uniform should be worn for games only and must be returned clean and mended at end of the season.
The child and parents will be responsible for the cost of repair or replacement for their uniform(s). This replacement cost is approximately $50.00.
The child will maintain a "C" average in school.
Students receiving an "F" in any subject will not practice or play games until grade returns to at least a "D".
The child is subject to follow the rules and regulations regarding athletics as deemed by Ss. Peter and Paul Catholic School.

I have read and agree to follow the entire Sports Permission Form
Key Phrase:
Enter Key Phrase:

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