Enrollment Contract

Please complete this form to enroll your student(s) for the next school year at St. Bernadette.

Student 1 Name*
First Middle Last
birth date*
Date Format: MM slash DD slash YYYY
Immunization Record*
Please upload your student's current immunization record.
Grade 2020-21
- Preschool
- Pre Kindergarten
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Student 2 Name
First Middle Last
birth date
Date Format: MM slash DD slash YYYY
Immunization Record
Please upload your student's current immunization record.
Grade 2020-21
- Preschool
- Pre Kindergarten
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Student 3 Name
First Middle Last
birth date
Date Format: MM slash DD slash YYYY
Immunization Record
Please upload your student's current immunization record.
Grade 2020-21
- Preschool
- Pre Kindergarten
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Student 4 Name
First Middle Last
birth date
Date Format: MM slash DD slash YYYY
Immunization Record
Please upload your student's current immunization record.
Grade 2020-21
- Preschool
- Pre Kindergarten
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Student ethnicity - please mark all that apply.
- American Indian or Alaskan Native
- Asian
- Black or African American
- Hispanic or Latina/o
- Native Hawaiian or Pacific Islander
- White
Parent / Guardian 1 Name*
First Last
Parent / Guardian 1 Address*
Street Address Address Line 2 City State ZIP Code
P/G 1 Phone*
P/G 1 Email*
P/G 1 Employer
P/G 1 Work Phone
Parent / Guardian 2 Name
First Last
Parent / Guardian 2 Address
Street Address Address Line 2 City State ZIP Code
P/G 2 Phone
P/G 2 Email
P/G 2 Employer
P/G 2 Work Phone
Student lives with:*
- Both adults at above address
- Adult 1 at above address
- Adult 2 at above address
Languages spoken at home*
Parish Membership*
- We are members of St. Bernadette Parish. Parishioners are families who have been registered in the parish for a minimum of 6 months and regularly worship with our community. Parishioners have a current Stewardship Pledge on file, honor their financial commitment to the Church with a suggested $25 weekly tithe, are actively involved in parish life, and have a Covenant for In-Parish tuition on file.
- We are members of another parish/faith. State faith and church name below.
- We are not members of a church community.
Parish Envelope Number / OR / State name of your church
Archdiocese of Seattle Photograph, Video/Sound, and Image of Work Consent*
- I, the parent/guardian of the above named student(s) authorize and give full consent, without limitation or reservation, to St. Bernadette to publish any photograph, video/sound or image of work in which the above named student(s) appears while participating in any program associated with St. Bernadette. There will be no compensation for use of any photograph, video/sound or image of work at the time of publication or in the future. If the student and/or parent/guardian wish to rescind this agreement they may do so at any time with written notice.
- I do not give permission to publish any photograph, video/sound or image of work of the above named student(s).
Please choose one.
Consent*
I/We agree to meet all requirements of time and funding as stated below. I/We agree to meet all tuition requirements as outlined on the Tuition Information Form (link below). I/We agree to abide by St. Bernadette School policies and procedures as outlined in the Family Handbook. I/We understand that any/all delinquent fees will be automatically collected by St. Bernadette School and/or SMART and a $50.00 monthly late fee will be applied.
To support the school and get to know the community better, returning St. Bernadette families are required, per the enrollment contract, to give 25 hours of service to the school or parish. New families have a commitment of 15 hours. Returning families are required to have at least five (5) hours of fundraising hours which include helping with a community dinner, the jog-a-thon, and chocolate sale. Hours not completed are billed at $25 per hour.

Tuition and Fee information: http://stbernadettesea.org/wp-content/uploads/2020/02/St-B-Tuition-Fee-2020-20-3.pdf

Volunteer information and opportunities here: https://stbernadettesea.org/volunteer-hour-reporting/
Signature Parent / Guardian 1*
Signature Parent / Guardian 2
Registration Fee Payment*
- Register 1 student
- Register 2 students
- Register 3 students or more
Registration fee is nonrefundable.
Total
$0.00
Credit Card

Card Details

Cardholder Name
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Enrollment Contract

Enrollment Contract