(office use only) Date Received: __________________ Parent's Name: _______________________________________________________________________
Address: _____________________________________________________________________________
City: ____________________________________ State: ___________ Zip: _______________________
Home Phone: _________________________________ Cell Phone: ______________________________
E-mail Address: ________________________________________________________________________
Are you Safe Environment Trained? ______ Date?________________ Parish? ______________________
Parent's Participation
Name of Parent Helping: ________________________________________________________________
Please mark your top 3 choices of open role(s) you would like to fill for the entire Co-op year.
1st & 3rd FRIDAYS IN THE CLASSROOMS
|
| Roles | Preferred Grade | Comment / Choice # |
| Teachers | Music
| Teachers assigned |
| Art | | |
History & Public Speaking | Teachers assigned |
Lunch Monitor & PE | | |
Math Fun K-2
| | 3-6 Teacher assigned |
Science 3-6
| | K-2 Teacher assigned |
Classroom Moms
| First 8 weeks
| Helpers assigned |
Last 8 weeks
| | |
| | Substitutes
| | |
1st & 3rd FRIDAYS IN THE NURSERY
|
| Roles | Comments/Choice #
|
Nursery Coordinator
| Coordinator assigned |
Nursery Leaders
| Helpers assigned
|
2nd & 4th FRIDAYS at a park
|
Roles
| Comments/ Choice #
|
Discussion Leader
| |
Please write your top 3 choices of field trips you would like to organize (see registration packet for calendar)
| Fieldtrip | Comments
|
| #1 | |
|
#2
|
|
|
#3
|
|
|
Amount Enclosed: $ ____________________________________ check # _________________________________ $75 payable to SHHE & $80 payable to Queen of Peace are non-refundable CLASS REGISTRATION IS ON A FIRST COME BASIS ACCOMPANIED WITH FULL PAYMENT. |
Emergency Contacts:
1. Name: _____________________________________________________________ Relation: _____________________
Phone: _______________________________________
2. Name: _____________________________________________________________ Relation: _____________________
Phone: _______________________________________
Please register ALL children attending K-6 Co-op including those using the nursery. If you are registering more then 5 children, please attach a separate piece of paper noting the information below.
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________ Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________ Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________ Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________ Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________ Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
I have read and understand ALL the information and policies noted in the registration packet. I agree to adhere to the parent and student expectations. I agree to ascribe to the mission statement, pledge loyalty to our Pope, the teachings of the Magisterium of the Catholic Church and to our diocesan Bishop. I also understand my fees are non-refundable.
__________________________________________________________________ _______________________________
Signature of Father, Mother, or Legal Gaurdian Date
Co-op
