956-973-8642

SAN MARTIN DE PORRES CATHOLIC SCHOOL

The only Catholic school in the Mid-Valley
REGISTRATION FORM 2014-2015
STUDENT: _____________________________ GRADE: ____ Gender M or F
First
Middle
Last
SS # ___________________
STUDENT: _____________________________GRADE: ____ Gender M or F
First
Middle
Last
SS # ___________________
DATE OF BIRTH: ______________PLACE OF BIRTH: ______________
MM/DD/YY
HOME ADDRESS: __________________________________________
CITY, STATE & ZIP CODE: ___________________________________
MAILING ADDRESS IF DIFFERENT: ____________________________
CITY, STATE & ZIP CODE: ___________________________________
HOME TELEPHONE: _______________________________________
ETHNICITY: ______________________________
LAST SCHOOL YOUR CHILD ATTENDED: _____________________________
ADDRESS: ____________________________________________________
PHONE NUMBER: ___________________________________________
BAPTIZED: YES OR NO
COMMUNION: YES OR NO

PARISH: ____________________
PARISH: ___________________

FATHERS NAME: _________________________________

First
Middle
Last
OCCUPATION: ___________________________________
EDUCATION LEVEL: _______________________________
BUSINESS OR EMPLOYMENT: _______________________
WORK PHONE NUMBER: __________________________
CELL OR OTHER NUMBER: _________________________
RELIGION: ______________________________________
MARITAL STATUS: ___MARRIED ___ SEPERATED ___DIVORCED
E mail: ___________________________________
MOTHERS NAME: _____________________________________
First

Middle

Last

OCCUPATION: ___________________________________
EDUCATION LEVEL: _______________________________
BUSINESS OR EMPLOYMENT: _______________________
WORK PHONE NUMBER: __________________________
CELL OR OTHER NUMBER: _________________________
RELIGION: ______________________________________
MARITAL STATUS: ___MARRIED ___ SEPERATED ___DIVORCED
E mail: ___________________________________
Is your income less than $30,000 a year? Yes or No

Child lives with: ___ both ___Father ___ Mother ___ other: _______________________________________________________________________
Does other parent have legal access? ___ Yes ___ No___ N/A
Home
language: ____________ Student speaks English: ___ frequently ___ somewhat ___ Very Little ___ none
____________________________
Parish in which family is registered: __________________________________________
__________________________________________
Name
City
Fathers Name:
I understand that my obligation as a parent include attendance at parents meeting, parent/teacher/student conferences and participate on fundraising activities, volunteer
activities and adherence to school rules and regulations.
FATHER: __________________________________________
_________________________________________
___________________________________________
_______________________
Parents Signature
Print Parents Name
Date

SAN MARTIN DE PORRES CATHOLIC SCHOOL

The only Catholic school in the Mid-Valley
REGISTRATION FORM 2014-2015
PARENT COMMITMENT FORM
FAMILY (LAST) NAME: ______________________
STUDENT: ____________________________________ GRADE: _________
STUDENT: ____________________________________ GRADE: _________
STUDENT: ____________________________________ GRADE: _________
STUDENT: _____________________________________ GRADE: ________

956-973-8642

FUNDRAISING COMITMENT

I/We agree to fulfill the Raffle/Event Commitment of $400.00 by

selling tickets or paying the full amount by fall
Parents Signature: __________________________Date: ___________

Non-refundable
Registration fee of $200.00:____
____
____
____
Tuition $3900.00

$ 99.00 if paid by April 1, 2014

$125.00 Material/Supply fee
$50.00 Technology Fee

____ 1 payment by September 1, 2014 (10% discount)

____ 10 months (390.00) beginning August 1, 2014
____ 11 months (354.55) beginning July 1, 2014

Discount of 10% for 2nd child, 20% for 3rd child, and 30% for 4th child
Financial Aid considered separately and adjusted to make the above amount.

I/We agree to fulfill the Raffle/Event Commitment of $200.00 by

selling tickets or paying the full amount by spring
Parents Signature: __________________________Date: ___________

I/We agree to assist in the activities of the PTC (Parent Teacher Club)
For at least 10 hours during the school year:
Parents Signature: __________________________Date: ___________

Tuition Payments are due on the 1st of each month. A late fee of $25.00 will be
assessed after the 5th of the month.
I/We agree to serve on PTC committees throughout the school year
2014.
Parent Signature: ____________________________Date: _______________
Parents Signature: _______________________ Date: ___________

SAN MARTIN DE PORRES CATHOLIC SCHOOL

The only Catholic school in the Mid-Valley
REGISTRATION FORM 2014-2015

SAN MARTIN DE PORRES CATHOLIC SCHOOL

TRANSPORTATION FORM
In order to provide for the safety of your child, please indicate for us who
will be picking up your child at the end of the school day.
If a person comes to school whose name is not listed, we will call you first to
get your approval. If you know ahead of time that someone else is coming,
please send that information with your child in the morning. We will keep
this information on file for that day.
My child oldest___________________________________ Grade_______
My other children: _______________________, ______________________
__________________________,_______________________________
The persons who have permission to pick him/her up are:
___________________________________Relationship_______________
___________________________________Relationship_______________
___________________________________Relationship_______________
___________________________________Relationship_______________
___________________________________Relationship_______________
It is the parents responsibility to notify the school if any changes are made.
_________________________________ ____________
Parents signature
Date

956-973-8642

PARENT PERMISSION FOR MEDIA RELEASE

We ask your permission to use your children/childrens name, picture or

comments in any materials used to promote Catholic Schools in the Diocese
or San Martin de Porres Catholic School, as well as to recruit new students,
and /or dispense public information.
Your signature below indicates your approval for said request for the
current school year only.
Thank you for your cooperation.

_______________________________________ ____________
Parent or Guardian Signature
Date
_______________________________________
Childs Name
_______________________________________
Childs Name
_______________________________________
Childs Name
_______________________________________
Childs Name

_____________
Date
_____________
Date
_____________
Date
_____________
Date

SAN MARTIN DE PORRES CATHOLIC SCHOOL

The only Catholic school in the Mid-Valley
REGISTRATION FORM 2014-2015

956-973-8642

EMERGENCY PROCEDURE INFORMATION

AGREEMENT FOR THE USE OF COMPUTERS AND TELECOMMUNICATIONS
STUDENT FORM

Students: ___________________________, _________________________

_______________________________, _____________________________

I have read the Acceptable Use of Policy for Computers and

Telecommunications. I understand its significance, and I agree to voluntarily
abide with the terms and conditions of it. I further understand that
violations of this agreement would be unethical and might even constitute a
criminal offense. Should I choose to violate this agreement, my privileges
will be revoked and disciplinary action, and/or appropriate legal action may
be taken.
Name of Parent/Guardian (Please Print) ______________________
Street Address: ___________________________________________
City/State/Zip: ____________________________________________
Home Phone: ____________________
Parent/Guardians work #: ______________

Student: _______________________________ Grade: ____________

Allergies: _____________________________________________________
Student: _______________________________ Grade: ____________
Allergies: _____________________________________________________
Student: _______________________________ Grade: ____________
Allergies: _____________________________________________________
Student: _______________________________ Grade: ____________
Allergies: _____________________________________________________
In case of an emergency and a parent cannot be reached, please indicate the
person (s) you want SMDPCS to contact, relationship, and phone number.
Name: ________________________Relationship: ___________Phone:_________
Name: ________________________Relationship: ___________Phone:_________
Name: ________________________Relationship: ___________Phone:_________

Has your child ever been tested for learning disabilities? Yes or No
If answer is yes, please provide the school at registration time with the copy
of the test and recommendations.
In case of an emergency and neither parent, nor any of the emergency contacts
listed can be reached, SMDPCS staff to call the necessary medical attention for
my/our child(ren). In the event that I nor the emergency contact I have listed
above can be reached. I/We ___________________________ authorized SMDPCS
staff to call for the necessary medical attention for my/our child (ren).

_____________________________________
Parent/Guardian Signature

_______________
Date

SAN MARTIN DE PORRES CATHOLIC SCHOOL

The only Catholic school in the Mid-Valley
REGISTRATION FORM 2014-2015

956-973-8642

FEDERAL PROGRAM

Family Name
_____________________________________________
Address
____________________________________________
City, State, Zip ______________________________________________
Signature of Parent/Guardian__________________________________
The following criteria issued by Texas public schools for eligibility for free
and reduced lunches and nutrition programs. We use it to determine
eligibility for our Federal Title Programs.
Household Size
Income
(Adults and children)
(As reported to IRS)
1
2
3
4
5
6
7
8
Each additional family member

$20,147
$27,214
$34,281
$41,346
$48,415
$56,482
$62,549
$69,516
$7,067

Using the information in this table, is your annual income equal or less
Than the amount shown for your family size?
Yes or No
Is your family eligible for food stamps? Yes or No
Does your family qualify for medical assistance under Medicaid? Yes or No
Is your family receiving supplementary security income?
Does your family receive housing assistance (Section 8)? )?
Does your family receive home energy assistance (LIHEP)?

Yes or No
Yes or No
Yes or No

Please list the students in your family attending our school:

Name____________________________________________Grade________
Name____________________________________________Grade________
Name____________________________________________Grade________
Name____________________________________________Grade________
Name____________________________________________Grade________
Thank you. This information is confidential and will be used only for the
purpose listed above.