(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
|
| Â Roles | Â Preferred Grade | Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Comment / Choice #Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â |
| Â Teachers | Music
| Teachers assigned |
| Â Art | Â | Â |
 History & Public Speaking | Teachers assigned |
 Lunch Monitor  & PE |  |  |
 Math Fun K-2
| Â | Â 3-6 Teacher assigned |
 Science 3-6
| Â | Â K-2 Teacher assigned |
 Classroom Moms
| First 8 weeks
| Helpers assigned |
Last 8 weeks
| Â | Â |
| Â | Substitutes
| Â | Â |
1st & 3rd FRIDAYS IN THE NURSERY
|
| Â Roles | Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Comments/Choice #Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
|
 Nursery Coordinator
| Coordinator assigned |
 Nursery Leaders
| Â Helpers assigned
|
 2nd & 4th FRIDAYS at a park Â
|
 RolesÂ
| Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Comments/ Choice # Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
|
Discussion Leader   Â
| Â |
Please write your top 3 choices of field trips you would like to organize (see registration packet for calendar)
|          Fieldtrip          |                          Comments                     Â
|
| #1 | Â |
|
#2
|
|
|
#3
|
|
|
Â
 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:_____________________Â Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________Â Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________Â Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________Â Gender: M / F (circle)
Allergies / Concerns: _________________________________________________________________________________
Student Name:______________________________________________________________________________________
Birth mm/yr:______________________________________ Grade or Age:_____________________Â 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                      Â
Â
