Enrollment Packet for 2015-2016

Contents:
1. Admission Policy
2. Mission Statement
3. Registration Form
4. Health Record/Medical Treatment Release Form
5. After-School Transportation & Publicity Authorization/Ethnicity
6. Child Registration Form
7. Concussion Law/Gym Permission Form
8. Tuition Rates/Collection Plan
9. Fundraising Contract
10. Tuition Contract
11. Volunteer Contract
*Use the following forms only if applicable
12. Tuition Assistance Qualification Procedure w attachments
13. George & Mary Kremer Foundation Application

*Please note that there is only 1 packet for this year and it can be printed/duplicated
from our school website: http://stmarys.eup.k12.mi.us/
To save time and money we are printing less. If you need a paper copy please stop
in the office.

ADMISSIONS POLICY:
St. Marys School is open to any child whose parents/guardians desire a Christian education for their
child.
Students will be admitted to St. Marys Parish Catholic School according to the following criteria:
1. January 1st-15th-registration will be accepted for the upcoming school year starting with children
of existing St. Marys Catholic School families, Pre-K 8.
2. January 16th -30th registration will be open to Catholic parishioners of The Diocese of
Marquette, Pre-K-8.
3. February 1st, registration will open to the public, Pre-K-8.
*A non-refundable deposit of $75.00 for K-8 and $35.00 for Pre-K will be required at the time of
registration to reserve the spot. Registration fees are due by May 1st. After May 1st, Registration
Fees are doubled to $150.
Kindergarten students must be 5 years old by September 01 of the year they intend to enter
Kindergarten. Exceptions are made for children whose birthday falls on or before December 31st and
show readiness, verified by a formal assessment and preschool teacher.
If classes become filled to capacity, any openings that occur will be filled from a waiting list. The
waiting list will be compiled on a first come first serve basis.
Registrations will not be taken after the first day of school except in the case of families new to the
area or under certain considerations with consultation of the St. Marys Education Commission. New
students will not be admitted into Grade 8 except under special circumstances and in consultation of
the School Commission.
Pre-School students must be 3 by September 1. Any openings that occur will be filled from a
waiting list. The waiting list will be compiled on a first come, first serve basis.
Transfer students: Transfer students shall be admitted to other grades upon evidence of having
satisfactorily completed previous grade levels.
**Please note that kindergarten entrance is based on the age policies listed for kindergarten, not upon
completion of the preschool program.
Revised: 9/23/2014

Mission Statement
Guided by the Holy Spirit and in partnership with the parents, St. Mary's School is committed to teaching the
knowledge of the faith centered in the person of Jesus Christ. The values and traditions of the Catholic faith are
integrated into a comprehensive academic program where each child can develop spiritually, intellectually,
emotionally, socially and physically. In a safe, joyful, and diverse environment, St. Mary's School will teach its
students the value of their Catholic heritage while respecting the traditions of students of other faith.
*Our Mission Statement is reviewed annually. Please contact the administrator if you have any questions or
recommendations regarding our Mission Statement. Revised 1/22/2013

*Please fill out

1 PER child

Date Paid_________
Initials_________
*office use only

Student Information
Childs Name (Last) ____________________ (First) __________________ (Middle) __________
Date of Birth __________________________ Sex: M / F Grade in Fall_______________
Primary Student address _________________________________________________________
City/Zip _______________________________________________________________________
Is your child a returning St. Mary's Catholic School Student YES or NO
A New Student YES or NO
***New students please attach a copy of Birth certificate and immunizations

Family Information
Parent/Guardian

Parent/Guardian #2

Full Name: _______________________________

___________________________________

Relationship ______________________________

___________________________________

Place of Employment ___________________

___________________________________

Occupation _______________________________

____________________________________

Marital Status __________________________

____________________________________

Religion ___________________________________

___________________________________

Address ___________________________________

___________________________________

______________________________________________

___________________________________

Phone (H) ______________(w)________________

___________________________________

Cell Phone _______________________________

____________________________________

Email _______________________________________

____________________________________

Drivers Lic _______________________________

____________________________________

Parish Information
______St. Marys

_____St. Josephs

Other ________________________

______Non Catholic
Are you registered in the indicated parish ______(yes) _____(no)

New students please complete this section:

List all schools previously attended

School year

Grade

School

City/State

*Please fill out

1 PER child

Health record/Medical Treatment Release Form

Name __________________________________________DOB ____________

Does your child have any chronic illness? YES or NO

Name of illness_________________________

Identify dates and causes of any operations, hospitalizations, significant injuries your child may have/had:
_______________________________________________________________________
_______________________________________________________________________
Does your child have an activity restrictions, including Physical Education Class? YES or NO
If Yes-what are his/her restrictions? _______________________________________________

My child is in good health YES or NO

My child is current on all immunizations YES or NO St. Marys has a copy of my childs immunization
records YES or NO
Wear glasses YES or NO

Date of last eye exam ____________

Has a hearing problem YES or NO

Is there anything else we should be aware of? YES or NO _____________________________
List allergies, medications
____________________________________________________________________________
____________________________________________________________________________
Please provide your name, address and phone number(s) and 2 people we can call in an emergency if
you cannot be reached:
Parent Name

Address

Phone #

As a parent/guardian, I do hereby authorize the treatment by a qualified and licensed Medial Doctor in an
emergency which, in the opinion of the attending physician, may endanger his/her life, cause a
disfigurement, physical impairment, or undue discomfort if delayed. This authority is granted only after a
reasonable effort has been made to reach me.

_______________________________________________________________
Parent/Guardian Signature
Health Insurance Information:
Company ______________________________
Group
______________________________

Date

Policy______________________
Policy Holder _______________

After school transportation/publicity authorizations/ethnicity form

Students name(s):

Grade:

_________________________________
_________________________________
_________________________________
_________________________________

_______
_______
________
________

*Only 1
form PER
family

Transportation - Please check any that apply:

____My child will walk home or to a day care provider
____Attend the After School Program
____Ride the bus to home or to day care provider
____Be picked up by parent/guardian or day care provider
____Other: __________________________________________________________________
If your child is being picked up by someone other than the parent/guardian, please write all the names and
telephone numbers of the person(s) who have authorization to pick up your child.
If your child is not picked up by 3:40pm, we will call the people on this list.

Name ________________________________ Phone __________________

________________________________
__________________
_______________________________________

______________________

*Are there any special circumstances that we should know of? If a special after school arrangement
exists that is not listed on this paper, please notify your childs teacher immediately in writing. YES
or NO

Picture/internet authorization
May we take your childs picture for use in the school newsletters, yearbooks, multi-media
presentations, brochures, flyers, social media sites, or for administration purposes? YES
May we post pictures of your child on the schools website which is public? YES
May we publish your name, address, and phone in the school directory?

or NO

or NO

YES or NO

Special instructions:

______________________________________________________________
Ethnicity/Race
The following information is optional but it helps our school for specific grants and also allows for our
school to participate in the share-time programs with the Sault Area Schools.
___ Caucasian/White ___ Hispanic/Black ___ American Indian/Native Alaskan __ Hispanic/White
___ Asian ___Multi Race __ Black __ Native Hawaiian/Pacific Islander __ Middle Eastern
Parents signature ______________________________________ Date _____________

Tuition Assistance Qualification Procedure

Families who qualify for free or reduced school lunches according to the federal
guidelines (see reverse), qualify for tuition assistance at St. Marys School. Families who
do not fall under these guidelines but are in need of assistance, must present a letter
explaining their families financial need, in addition to filling out the Student Grant Parent
Form and supplying the requested documentation, no later than May 15th.

Families at St. Marys School who wish to apply for tuition assistance for the next school
year, must submit the Student Grant Parent Form and a copy of Income Tax Return 1040
form or other source of proof of income, no later than May 15th.

St. Marys Schools Finance committee will meet during the month of June to award
tuition assistance in the following order:
1. Families who qualify for free lunch under the federal guidelines will pay $650.00 per
family per year and will be given first consideration.
2. Families who qualify for reduced lunch under the federal guidelines will pay one-half
of the total family tuition and will be given second consideration.
3. Families who do not fall under these guidelines, but are in need of assistance will be
given a tuition award depending on the amount of money left in the budget for tuition
assistance and determined by a committee comprised of pastor, administrator and
financial committee member.
4. These formulas for tuition assistance awards are subject to change depending on the
number of requests received in each particular year and the amount of money
available in the tuition assistance fund.
5. All tuition amounts can be paid in installments throughout the current school year.
Collection of this tuition will be followed in the same manner as the Tuition
Collection Policy.
6. The process will be confidential to the school Secretary, school Administrator and
Tuition Award Committee.

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TUITION SCHEDULE 2015-2016

Registration
Tuition

10 Monthly Payments (Sept-June)

Parishioner Rate
1st Child
$75
nd
2 Child
$75
rd
3 Child
$75

$2337
$1854
$1161

$233.70
$185.40
$116.10

Non Parishioner Rate

1st Child
$75
nd
2 Child
$75
rd
3 Child
$75

$3497
$3013
$2200

$349.70
$301.30
$220.00

Pre School Rates

1st Child
Multiple child rate

$1539
$1334

$153.90
$133.40

K-8 Registration Fee - $75.00 per child prior to May 1. After May 1, $150.00.
Pre-School Registration Fee - $35.00 per child prior to May 1. After May 1,
$70.00

*Registration Fee is due at the time of Registration.

*The monthly payments do not include the Registration Fee.

IMPORTANT
Families claiming parishioner status must be able to demonstrate active
participation in the life of the parish through weekly use of tithing envelopes and
their presence at Sunday Mass. Parishes will verify active membership before
the beginning of the school year.

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TUITION COLLECTION PLAN

Families who have:

Completed the registration process;

Paid the registration fee; and

Do not have delinquent tuition from the prior school year

Are eligible to attend St Marys School if all of these requirements are met be May 31st.
In addition to the above requirements, one of the following methods of payment must be elected
BY MAY 31st, to insure cash flow for the school year:
Option A-

Enrollment with the Diocesan Payment Program by May 31st and by making ten
(10) monthly payments, September thru June with each payment due on the 15th
day of each month. The monthly payments must be current and must remain
current; OR

Option B-

Payment of the full amount of tuition payable by the 15th day of August prior to
the start of the school year.

Tuition Assistance:
Tuition assistance is not guaranteed after May 1st. Upon qualification of Tuition
Assistance, each family shall follow the ten monthly payment plan listed under
Option A above.
If Tuition Assistance is denied, the family shall have 30 days to choose one of the payment
options listed above without penalty.

Nonpayment of Tuition:
Families who have not fulfilled their tuition commitment for the current school year will not be
able to attend St. Marys School in September until the tuition and applicable late fees are paid in
full. If the child(ren) have already registered for the upcoming school year, they shall be
removed from the registration list and will no longer be given pre-registration priority. If they
have not registered, then they shall not be allowed to register until all past due tuition and late
fees are paid in full and they have enrolled in one of the payment options listed above. In any
event, all past due and current tuition shall be current before the family can register or enroll in
St. Marys School. If any family becomes delinquent on their tuition for sixty (60) days, then
they shall appear before the St. Marys School Board to explain their situation and to show good
cause. After the Boards written decision, any payments not made within 15 days can be turned
over to an agency for collection.

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New Student Policy:

Students entering St. Marys School after the start of school shall pay the registration fee and
shall be charged tuition on a pro-rata scale. New students must be registered in one of the plans
as provided by the Tuition Collection Plan. If the payment in full option (Option B) is selected
then the family will have 30 days (from the date of registration) within which to make payment.
If they do not, then their child shall not be allowed to attend school. If Option A is selected
(Diocesan Payment Plan) then they must enroll with the Diocesan Payment Plan within seven
days from the date of registration and the first months tuition payment must be paid at the time
of enrollment.

Tuition Refund Policy:

Tuition shall be refunded, on a pro-rata basis, or Smart Contract terminated, only if one of the
following conditions have been met:
a. extenuating circumstances, i.e. death, disability of a household income earner or other
uncontrollable situations - to be submitted in writing and presented to the St. Marys
School Commission and determined by a majority vote of the St. Marys School
Commission to be extenuating;
b. Commission action terminating a student; or mutual consent of the school and family
for the best interests of the student.

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Fundraising Contract (K-8)

Fundraising Contract Families with only pre-school students, complete reverse

*Only 1
form PER
family

JACKPOT RAFFLE Kindergarten - 8th Families

The Jack Pot Raffle is a mandatory fundraiser. The money generated from the fundraiser is a component
of our budget. Therefore, everyone is required to participate or to pay an equivalent in lieu of participating
in the fundraiser. Each family is required to sell 25 tickets or make a single payment of $500. If you
choose to make the single payment, it is due at the time you register your child for school (you will then
be able to keep 25 tickets for yourself to enter into the drawing).
I/We ___________________________________________WILL PARTICIPATE IN THE JACKPOT
RAFFLE AND SELL 25 TICKETS BY THE RAFFLE DEADLINE.
I/We ___________________________________________ WILL BE PAYING $500 IN LIEU OF
PARTICIPATION IN THE JACKPOT RAFFLE.
SCRIP PROGRAM Kindergarten 8th Families
The SCRIP program is run by the administration of the Catholic School in conjunction with the Diocese of
Marquette using a volunteer core as required by government regulations.

All families are required to generate a minimum profit in the amount of $20.00 during the 201415 school year, with a cutoff for earning on June 30, 2015. Any difference will be billed to the
parents tuition account for the 2015-16 school year or a bill will be sent to those families not
returning in 2015-16.

2. You may opt out of the SCRIP program by paying the $20.00 fee at the time you register
your child for school.
7. Any excess profit over the $20.00 amount will be credited to the parents tuition account
at a 50% rate as a SCRIP tuition credit in the next school year.
8. All SCRIP Tuition Credits are taxable income. A 1099 will be issued by the school for
SCRIP tuition credit in excess of $600.
_____________________________
Parents Signature

_________________________________
Parents Signature

_____________________________
Date

_________________________________
Date

Those families who have personal or financial concerns with this policy may request a meeting
with the school board to discuss the matter.
*****************Families with only Pre-School students, complete reverse*****************

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*Only 1
form PER
family
Fundraising contract for Pre-school ONLY
JACKPOT RAFFLE
The Jack Pot Raffle is a mandatory fundraiser. The money generated from the fundraiser is a component
of our budget. Therefore, everyone is required to participate or to pay an equivalent in lieu of participating
in the fundraiser. Each family is required to sell 12 tickets or make a single payment of $240. If you
choose to make the single payment, it is due at the time you register your child for school (you will then
be able to keep 12 tickets for yourself to enter into the drawing).
I/We ___________________________________________WILL PARTICIPATE IN THE JACKPOT
RAFFLE AND SELL 12 TICKETS BY THE RAFFLE DEADLINE.
I/We ___________________________________________ WILL BE PAYING $240 IN LIEU OF
PARTICIPATION IN THE JACKPOT RAFFLE.
SCRIP PROGRAM Pre-School
The SCRIP program is run by the administration of the Catholic School in conjunction with the Diocese of
Marquette using a volunteer core as required by government regulations.
1. All families are required to generate a minimum profit in the amount of $10.00 during
the school year, with a cut off for earning on June 30. Any difference will be billed to the parent's
tuition account.
2. You may opt out of the SCRIP program by paying the $10.00 fee at the time you register
your child for school.
3.

Any excess profit over the $10.00 amount will be credited to the parents tuition account
at a 50% rate as a SCRIP tuition credit in the next school year.

4.

All SCRIP Tuition Credits are taxable income. A 1099 will be issued by the school for
SCRIP tuition credit in excess of $600.
_____________________________
Parents Signature

_________________________________
Parents Signature

_____________________________
Date

_________________________________
Date

Those families who have personal or financial concerns with this policy may request a meeting
with the school commission to discuss the matter.

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FAMILY ID #: ___________
FAMILY NAME: _____________________________________________
Last

First Name(s)

ST. MARY CATHOLIC SCHOOL

TUITION CONTRACT
For the 2015-2016 school year, I commit myself to pay the tuition and fees as follows:
(A) Tuition (transfer this figure from local adjustment sheet)

$ ____________

(B) Fees (transfer this figure from local adjustment sheet)

$ ____________

TOTAL GROSS TUITION & FEES FOR THE YEAR WILL BE:

$_____________

Scrip Credit

($____________)

Local School Discount

($____________)

Scholarship Credit

($____________)

Employee Discount

($____________)

TOTAL NET TUITION

$____________

Please choose one of the payment options below:

____Option 1: One time full amount payment
___ Payment will be made by cash or check directly to Diocese of Marquette/School
___ Payment will be made by ACH (complete ACH section on reverse side)
___ Payment will be made by credit card
***An additional 3% will be added to your monthly payment if you use this option,
to cover bank fees.
____ Option 2: Monthly payments
____ By cash or check directly to Diocese of Marquette/School
(all bills will be sent via email) Email bills to _______________________________
____ By ACH/EFT payments beginning September 15 and end June 15.
____ By credit card payments beginning September 15 and end June 15.
***An additional 3% will be added to your monthly payment if you use this option,
to cover bank fees.
Signature: __________________________________________________ Date:______________________________
Parent, Guardian or Person who is Financially Responsible

Reviewed by: _______________________________________________ Date: _____________________________

Signature of Pastor
Approved by: _______________________________________________ Date: _____________________________
Signature of Principal

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(If paying by debit or credit card please complete the ACH Form)

ACH WITHDRAWAL AUTHORIZATION

I/WE hereby authorize the Diocese of Marquette to transfer funds for the sole purpose
of collecting tuition and fees. The funds are to be transferred from my/our:

Checking Account*

OR

Account #____________________

Savings Account

Routing #_______________________

At _______________________________________
(Name of Financial Institution)

Please verify your account number.

*PLEASE ATTACH A VOIDED CHECK
ACH withdrawals will be made on the 15th of each month according to the payment schedule indicated on
the contract. Amounts maybe adjusted after other credits and/or scholarships have been applied.
This authorization allows the Diocese of Marquette to initiate the debit entry via ACH indicated above and
to initiate, if necessary, any reversal entry and adjustments for entries made in error to the accounts
indicated above.
This authority is to remain in full force and effect until the Diocese of Marquette has received written
notification of its termination in such time and in such manner as to afford the Diocese of Marquette a
reasonable opportunity to act on it. The Diocese of Marquette may terminate ACH agreement due to, but
limited to, Non-Sufficient Funds.

Date___________ Account holder signature __________________________

CREDIT CARD AUTHORIZATION

Please charge my credit card for the total amount as indicated on my tuition contract.
Name as it appears on Card _______________________________________________

Visa

MasterCard

Discover

Card #: ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___ - ___ ___ ___ ___
Expiration Date ____________________

Security Code _________

Signature __________________________________________

Date ___________
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ST. MARY CATHOLIC SCHOOL

LOCAL ADJUSTMENTS
2015-2016 School Year
Non-Participating Catholic
/
Non-Catholic

Participating Catholic
# of Children Enrolled

PRE-K

K-8

PRE-K

1 child only
2nd child
3rd child or more

Names(s) of Student(s)

Grade Entering

TUITION FOR THE YEAR WILL BE:

(A) transfer this figure to the tuition contract

Tuition

$_____________

Fees:
Registration Fee due at the time of application (due at time of application)

$____________

Other Fees

$____________

FEES FOR THE YEAR WILL BE:

(B) transfer this figure to the tuition contract

$____________

Credits:
Scrip Credit
($___________)
Tuition Commitment Statement (Please check one statement and sign commitment)
______I am a parishioner of _______________________Catholic parish. I have read and signed the Tuition
Contract and the Tuition Collection Policy in my Registration Packet. Families claiming parishioner status must be
able to demonstrate active participation in the life of the parish through the weekly use of tithing envelopes
and their presence at Sunday Mass. Your parish priest or parish representative will sign the Tuition Contract
as verification of active participation.
______I am a non-parishioner. I have read and signed the Tuition Contract and the Tuition Collection Policy in my
Registration Packet.
_____________________________________________ ___________________________________________
Printed Name Printed Name
_____________________________________________ ___________________________________________
Parent Signature Date Parent Signature Date
_____________________________________________ ___________________________________________

Drivers License Number

Drivers License Number

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*Only 1
form PER
family

Parental involvement contract

Parental involvement is essential for keeping tuition costs as low as possible and in creating the family
atmosphere so important to the school mission. Each family, Kindergarten 8th, is required to give a
minimum of 30 hours annually of volunteer services. Each family, with only Pre-school students,
is required to give a minimum of 15 hours annually of volunteer services. Every family is
responsible to participate in at least one Parent Involvement Opportunity. Volunteer hours can be earned
by parents or relatives 18 years of age or older. After reviewing the Parent Involvement Opportunities,
please complete the section below.
All volunteer hours MUST be documented in the Service Hours book located in the office.

Last Name ______________________

Phone Number ___________________________

Fathers Name ___________________ Address ________________________________

Mothers Name ___________________ _______________________________________
Email __________________________________
Students Name(s) _______________________________________
_______________________________________
_______________________________________
_______________________________________

Grade __________
__________
__________
__________

I would like to work on the following committees:

1st ________________________________ 4th __________________________________
2nd _______________________________

5th

_____________________________________________________

3rd ________________________________________ 6th _________________________________________

I understand and agree that parent involvement is an important part of St. Mary's Catholic School. I
accept my responsibility of the requirements set forth by the School Board.

Signature _______________________________ Date ________________

Signature ______________________________ Date _________________

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Parent involvement opportunities

Advertising & Marketing: Someone to organize and contact advertising media for school promotion and events. Media
list is available for reference. *Note-Hours are for actual time completing task, not value of advertising.
Athletics: Coach or be an assistant coach for St. Mary's Catholic School teams. Teams will include boys and girls
basketball and cheerleading squads.
Baking: Several events throughout the year will require refreshments. A donation of baked goods needed will be asked
prior to the event. Your baking time can be used as service hours.
Book Fair: Work with Scholastic Books to run a book fair twice a year. Book fairs usually run for a 1 week period.
Box tops/Soup Labels: Collection and transmittal of labels/box tops etc... to companies for educational promotions.
You may choose just one, i.e. box tops or soup labels.
Building improvement committee: Responsible for organizing and participating in all building improvement activities.
Catholic Schools Week: Be heavily involved one week of the year to volunteer, organize, supervise and attend events
for Catholic Schools week.
Christmas Program Costumes: Assist classes in cutting/hot glue/sewing costumes for the Christmas program.
Classroom aides: Volunteer Teacher Aides who can make a regular commitment.
HASA: Attend Home & School Association meetings for service hours; or run for a position on the Home & School board.
Home Room Supervisor: Work in coordination with teachers and HSA to help complete classroom assignments for
fundraising, classroom parties and projects etc...
Hot Lunch Helpers: Volunteer to help serve lunch or breakfast one or more days (one hour commitment per day).
Inkjet & Cellphone recycling: To collect empty inkjet cartridges and unwanted cellphones, count them and return them
to the company. Boxes for collection will be placed at school and local Churches.
Jackpot Raffle: Distribute and collect tickets. Help organize event. Work at event.
Library: Volunteer to be a library aide. This is a one hour per week commitment per class.
Marketing Committee: assist with promoting events, post to social media, and assist with newsletters
Moving & Storage: Often we are in need of parents who are willing to pick-up items from/for the school and
deliver/unload them. These are often large items that require a truck.
Painting: Paint needed walls, rooms, objects, etc
Recess: One hour per week commitment to supervise outdoor/indoor recess.
St. Marys School Education Commission: Attend School Board meetings for service hours/run for a School Board
Used uniform locker attendant: St. Marys has lockers near the gym that house used uniforms for giveaway. As people
drop off donations and students use the uniforms throughout the school year, they are in constant need of upkeep
(folding, sorting & storing).
*Many other opportunities will present themselves throughout the school year. Follow Facebook Page-St. Marys
School

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