Registration Form

Please click the download link below to download the Registration Form. Once you have completed the form, please mail the form to the address listed on the form with your payment.

Download

Registration Form

Student Information

Please fill in the requested information.

Name

Prefix

First

Last

Suffix

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Phone Number

###

####

Date of Birth, Place of Birth

Grade Entering, Age, & Gender

Ethnicity, Religion, & Previous School

If Catholic, please provide the following information: (for the student)

All fields are required.

Baptism Date, Parish, & City

First Holy Communion Date, and Parish

City & State

Parent Information

Please enter the Mother’s Information below. All fields are required.

Mother’s Name

Prefix

First

Last

Suffix

Phone Number

###

####

Work Phone Number

###

####

Cell Phone Number

###

####

Employer, Ext, Department, & Occupation

Religion, If Catholic what Parish

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Marital Status

Single

Married

Divorced

Widowed

Parent Information

Please enter the Father’s Information below. All fields are required.

Father’s Name

Prefix

First

Last

Suffix

Home Phone Number

###

####

Work Phone Number

###

####

Cell Phone Number

###

####

Employer, Ext, Department, & Occupation

Religion, If Catholic what Parish

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Marital Status

Single

Married

Divorced

Widowed

If parents are separated/divorced, a copy of the Custody Agreement must be on file in the Our Mother of Mercy Catholic School
Office.

2011-2012 RATES: Registration $75.00 – Maintenance Fee $375.00 due May 15th. Both Fees are Non-Refundable.

CERTIFICATION FORM 2011-2011

***COMPLETED REGISTRATION PACKET WILL NOT BE PROCESSED without all required forms. Registration fee of $75.00 and***

Maintenance/Book fee of $300.00 due by May 15th. Both Registration fee and Maintenance/Book fees are Non-Refundable. ***

Please enter required fields below.

Student Name and Grade

Address

Street Address
Address Line 2
City	State / Province / Region
Postal / Zip Code	Country

Home Phone Number

###

####

Alternate Phone Number

###

####

PARENT/GUARDIAN RESPONSIBLE FOR TUITION

PARISH OF PARENT/GUARDIAN OF STUDENT

Are you a registered contributing member of that Parish?

Yes

Digital Parent Signature

Enter your Full Name above.

Section Break

Dear Parent/Guardian,

Please fill out the above form in order that your child might receive parish certification to attend Our Mother of Mercy Catholic School. Parish certification does not determine the amount
of tuition. It does affect other reports and assessments for the School year and the Diocese of Beaumont. Please forward this form to your pastor for certification. Your pastor can verify
and return the certification form to the School or return to you to bring in. If there is some reason your child cannot be certified, we will notify you. It will be your responsibility to
arrange a meeting with your pastor to discuss the certification process.

Sincerely,

Dorothy Wheaton

Dorothy Wheaton, Principal

Entry Interview Form

A description of the section goes here.

Student Name & Grade

School

School Attended Prior To This One

Reason(s) For Enrolling (Please be as specific as Possible):

How did you learn about this school?

Principal: Please send a copy of this form to the Superintendent of Schools.

Email *