St. John the Evangelist School Registration 1/2014 ST. JOHN THE EVANGELIST SCHOOL 5701 LOCUST AVENUE CARMICHAEL, CALIFORNIA 95608 (916) 481-8845, EXTENSION 216 www.stjohnev.com SCHOOL INFORMATION SHEET Thank you for your interest in St. John the Evangelist School. The following information is provided to help you make a decision before completing the application form. School hours for students in Grades K through 8 are 8:15 - 3:00. School hours for Transitional Kindergarten are 8:15 – 12:00. Extended Day Care for TK through 8 is available for a reasonable cost from 7:00 a.m. - 6:00 p.m. on days school is in session. Class sizes vary. Students wear uniforms. A lunch program is available. We have an active Parent Club. All parents are members. Parents of students in grades TK-8 have a work service hours requirement each school year. There is a non-refundable registration fee per student. This fee partially covers diocesan assessment, standardized testing, student insurance, parent ministry, some field trip fees, textbook use, and includes a copy of the yearbook. The 2014-2015 registration fee for Grades K- 8 is $275.00 per student. Transitional Kindergarten pays $125 each. This includes the cost of a yearbook. Students participating in after-school sports, graduation, Confirmation or First Communion and some field trips and other activities will be required to pay additional fees during the school year. 2014 – 2015 TUITION RATES PARISH* NON-PARISH One Child 4,580 5,640 Two Children 8,250 10,150 Three or More Children 11,000 13,540 Transitional Kindergarten 2,680 per student *A parishioner is someone who is an active participant in St. John the Evangelist Parish. An "Active Participant" is someone who is formally registered in the parish, who regularly attends Mass at our church and uses the parish envelopes or Parish Pay to contribute financial support to our parish.
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St. John the Evangelist School Registration 1/2014 1/2014
ST. JOHN THE EVANGELIST SCHOOL 5701 LOCUST AVENUE
CARMICHAEL, CALIFORNIA 95608 (916) 481-8845, EXTENSION 216
www.stjohnev.com
SCHOOL INFORMATION SHEET
Thank you for your interest in St. John the Evangelist School. The following information is provided to help you make a decision before completing the application form.
School hours for students in Grades K through 8 are 8:15 - 3:00. School hours for Transitional Kindergarten are 8:15 – 12:00. Extended Day Care for TK through 8 is available for a reasonable cost from
7:00 a.m. - 6:00 p.m. on days school is in session. Class sizes vary. Students wear uniforms. A lunch program is available. We have an active Parent Club. All parents are members. Parents of
students in grades TK-8 have a work service hours requirement each school year.
There is a non-refundable registration fee per student. This fee partially covers diocesan assessment, standardized testing, student insurance, parent ministry, some field trip fees, textbook use, and includes a copy of the yearbook. The 2014-2015 registration fee for Grades K- 8 is $275.00 per student. Transitional Kindergarten pays $125 each. This includes the cost of a yearbook. Students participating in after-school sports, graduation, Confirmation or First Communion and some field trips and other activities will be required to pay additional fees during the school year.
2014 – 2015 TUITION RATES
PARISH* NON-PARISH
One Child 4,580 5,640
Two Children 8,250 10,150
Three or More Children 11,000 13,540
Transitional Kindergarten 2,680 per student
*A parishioner is someone who is an active participant in St. John the
Evangelist Parish. An "Active Participant" is someone who is formally
registered in the parish, who regularly attends Mass at our church and uses
the parish envelopes or Parish Pay to contribute financial support to our
parish.
St. John the Evangelist School Registration 1/2014 1/2014
St. John the Evangelist School 5701 Locust Ave
Carmichael, CA 95608 (916) 481-8845, Ext. 216
2014-2015 Registration Agreement The St. John the Evangelist parish school community believes that the primary responsibility of education lies with the parents and/or guardians of children, and that any successful educational program depends upon the positive and active cooperation and involvement of the parents or guardians with and in the school. As registered families of St. John the Evangelist School, it is expected that families will be involved on a voluntary basis to provide support services which will benefit the school community.
COMPLETE THE FOLLOWING INFORMATION AND RETURN THIS REGISTRATION AGREEMENT INCLUDING YOUR REGISTRATION FEE. IF YOU NEED FURTHER INFORMATION CONCERNING REGISTRATION, PLEASE CALL THE SCHOOL OFFICE FOR AN APPOINTMENT. PLEASE PRINT.
1. FULL NAME OF STUDENTS Date of Birth Grade in 2014-2015
_____________________________ __________ _________________ LAST FIRST MIDDLE ____________________________ __________ _________________ LAST FIRST MIDDLE ___________________________ __________ _________________ LAST FIRST MIDDLE
6. Are parents separated? Yes _____ No _____ Divorced? Yes _____ No _____ If so, who has legal custody? _____________________________ NOTE: A copy of court custody decision must be in our school files or joint custody will be assumed.
We grant permission to St. John the Evangelist to take photographs of our child(ren) for the school website and other publications for the purpose of displaying school activities, events and classroom participation. We also understand that first names only may be used when appropriate. If I choose not to have my child(ren) picture used for the school website and other publications, I will notify the school office in writing no later than August 15, 2014.
I//We have read and understand the Registration Form for School Year 2014-2015. It is understood that registration will not be final until tuition is current, and all fees/late charges are paid, volunteer hours for the previous year have been served, and the registration fee is processed.
St. John the Evangelist School Registration 1/2014 1/2014
ST. JOHN THE EVANGELIST SCHOOL SCHOOL YEAR 2014-2015
REGISTRATION FEES Grades K thru 8th $275.00 per child
ANNUAL TUITION RATES
ONE CHILD TWO CHILDREN THREE + CHILDREN
Parish Rate 4,580 8,250 11,000
Non-parish Rate 5,640 10,150 13,540
St. John the Evangelist School parish tuition rate is for families that are active participants in the life of the parish. "Active Participants" are those families who are formally registered in the parish, who regularly attend Mass at our church, and use the parish envelopes or Parish Pay to contribute financial support to our parish. A parishioner serves the community of St. John’s through volunteer efforts and prayer. St. John the Evangelist School non-parish rate is for all families who do not conform to the above definition.
SCRIP PROGRAM
Each school family is subject to an annual $200.00 Scrip Program Fee. This financial obligation may be satisfied in cash or by choosing to participate in our “Store Contribution Program” as follows:
1. Raley’s, Bel Air, and Nob Hill Grocery Stores – Link individual “store card” to St. John the Evangelist School and use this card each time you shop at any of these stores. The contributions based on your store purchases and submitted to St. John the Evangelist School quarterly by the family, will be credited to your Scrip Program Fee.
2. SaveMart Grocery Stores – Pick up card at school office. Use card at store and turn in receipts to school office at the end of each month. Write family name on receipts before submitting. The contributions to St. John the Evangelist School based on your store purchases will be credited to your Scrip Program Fee.
3. E-Scrip: This includes stores such as Safeway and various other vendors (see www.escrip.com for complete list). Your store card, credit cards or debit cards must be linked to St. John the Evangelist School. The contributions based on your store purchases and submitted to St. John the Evangelist School on E-Scrip’s report will be credited to your Scrip Program Fee.
4. Gift cards/paper scrip sold periodically during the school year – The amount of return varies by vendors listed on the order form. The percent of return is shown in parentheses on the form. The percent of return amount earned is credited towards your Scrip Program Fee each time you purchase.
5. Credits made to your Scrip Program Fee will be based on contributions to the school during the period March 1, 2014 through February 28, 2015. 6. A school family may satisfy a portion of this financial obligation with participation in the Store Contribution Program and a portion in cash. 7. Balance due for Scrip Program Fee will be remitted with 2015-2016 registration or no later than April 10, 2015 for families not returning.
TRANSITIONAL KINDERGARTEN
Registration Fee for TK is $125 per child. Annual Tuition Rate for TK is $2,680 per child. TK tuition payments are paid on a ten month basis, August through May, $268 per child monthly. There is only one tuition rate for TK. Scrip Program Fees and Service Hour Requirements are applicable to TK-8 families only.
St. John the Evangelist School Registration 1/2014 1/2014
ST. JOHN THE EVANGELIST SCHOOL 5701 Locust Avenue
Carmichael, CA 95608
SCHOOL FINANCIAL AGREEMENT 2014-2015
Family Name: _______________________________________________________________________ Person Responsible for Payment: ________________________________________________________ PLEASE INITIAL THE FOLLOWING IN THE SPACE PROVIDED: ______ 1. I agree to pay a non-refundable registration fee of $275.00 per child, grades K thru 8
th or $125
per child, grade TK. ______ 2. I agree to pay an annual tuition rate based on the number of children I have enrolled at St. John the Evangelist School. ______ 3. I agree that in order to receive the parish tuition rate at St. John the Evangelist School, I must be an “active participant” in St. John the Evangelist Parish as described on the “Registration Fee” page of this packet. ______ 4. I agree to pay the non-parish tuition rate if I do not meet the requirements as noted in #3 above. ______ 5. I understand that school tuition fees are based on a 180-day academic year and are divided into 10 monthly payments beginning August 15
th and ending on May 15
th for grades TK thru 8
th.
______ 6. I understand that tuition payments are due on the 15
th day of each month, August through
May. ______ 7. I understand that there is a $55.00 late fee for tuition payments after the 25th of the month and a $30.00 fee for a returned check. ______ 8. I understand that if my tuition fees are not paid when due, my child/children may be prohibited from attending class; if a tuition account remains unpaid for more than 30 days, my child/children may be asked to leave the school. ______ 9. I understand that report cards for all grades and diplomas for 8
th grade may be held if a tuition
account or any other financial account is delinquent. ______10. I understand that tuition is an annual fee and there is no reduction in fees for illness, missed days, holidays or vacation days. ______11. I understand that I will sign up and make payments through Smart Tuition. *See information in the following letter. I HAVE READ AND UNDERSTAND THE CONTENTS OF THIS AGREEMENT: ____________________________________________ ________________ Parent/Guardian Signature Date ____________________________________________ ________________ Parent/Guardian Signature Date
St. John the Evangelist School Registration 1/2014 1/2014
ST. JOHN THE EVANGELIST SCHOOL GRANDPARENTS AND SPECIAL FRIEND
ADDRESS LIST
As we look toward “building family and community” at St. John’s, we realize that our extended family also enjoys hearing good news. With this in mind, we would like to be able to let grandparents know when their grandchildren receive positive recognition at our school. The response from this program this past year was wonderful as grandparents received special mail about their beloved grandchildren. If you would like, please take a moment to complete this form. Please keep information updated during the year. We have included “special friend” because, sometimes, in place of a grandparent, there may be a special older neighbor or a relative who would like this news. Student’s name(s)______________________________________________________ Grandparent(s)________________________________________________________ Street_______________________________________________________________ City, State & Zip______________________________________________________ Grandparent(s)________________________________________________________ Street_______________________________________________________________ City, State & Zip______________________________________________________ Special Friend________________________________________________________ Street_______________________________________________________________ City, State & Zip______________________________________________________
St. John the Evangelist School Registration 1/2014 1/2014
IMPORTANT: RETURN COMPLETED FORM TO SCHOOL OFFICE EMERGENCY INFORMATION (please print)
Family Name _______________________________ Home Phone _____________________ Mother’s Name _______________ ______________ Father’s Name _________ ______________ First Last First Last Child’s Name _______________________________________ Grade ________ _______________________________________ ________ _______________________________________ ________ Child’s address ___________________________________________________________________ City Zip Business Phone: Mother_____________________________ Father _______________________ Cell Phone: Mother _________________________________ Father _______________________ E-mail: Mother _____________________________________ Father_______________________ Name and telephone of two local persons who will pick up and care for child in an emergency: 1. _________________________________ Phone ______________ Relationship ______________ 2. _________________________________ Phone ______________ Relationship ______________ My child is allergic to ______________________________________________________________ Name of child’s physician _____________________________________ Phone _______________
AUTHORIZATION OF CONSENT FOR TREATMENT OF MINOR In the event of serious emergency and none of the persons listed above can be contacted, I authorize school officials to call the child’s physician, or if the situation demands, to transfer my child to the nearest hospital/medical facility for emergency care. I consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment which is deemed advisable by and rendered under the general or special supervision of any physician and surgeon licensed under the provision of the Medicine Practice Act, whether such treatment is rendered at the physician’s office or at a certified hospital. I HEREBY AGREE TO BEAR ALL COST INCURRED AS A RESULT OF THE FOREGOING.
_______________________________________ _________________________________________ Signature of parent Date I do not choose to sign the above agreement. In the event of an accident or emergency, please:
___________________________________________ ____________________________________ Signature of Parent Date
St. John the Evangelist School Registration 1/2014 1/2014
St. John the Evangelist School 5701 Locust Avenue
Carmichael, CA 95608 (916) 481-9945, Extension 216
AUTHORIZATION TO PICK UP CHILD FROM SCHOOL
Child’s name___________________ Grade ______ Child’s name___________________ Grade ______ Child’s name___________________ Grade ______ (Please include siblings, persons with whom you car pool, etc. Only those listed may pick up from school. Extended Day program has a separate pick up form. Please send a note or call the school office if someone not listed will be picking up your child on a particular day.) The following people are authorized to pick up my child/children:
St. John the Evangelist School Registration 1/2014 1/2014
Family Work Service Hour Opportunities
FAMILY NAME:
PHONE: E-MAIL:
Each family is required to complete a minimum of 40 hours of service. This includes 7 service hours related to the Craft Fair. No transferring hours to another family. Listed are most of the opportunities for which you can earn work service hours. Please indicate those opportunities in which you’d like to participate. Signing-up does not guarantee working on the selected opportunity. Even though your family may reach the required minimum work service hours, we still need your help throughout the school year. Each family is responsible for recording their own work service hours through the school web site or by submitting a service hour form to the school office. Work service hours are recorded from March 1, 2014 through February 28, 2015. Incomplete work service hours may result in a higher registration fee or losing your child’s place in our school. Registration will not be final until the work service hour obligations for the 2013-2014 school year have been satisfied.
Crab Feed (February)
Co-chairperson-name:
Kitchen Coordinator-name: Kitchen Help-name: Server Coordinator-name: Server-name:
Bar Coordinator-name: Bar Help-name: Set Up/Decorate-name: Clean Up Coordinator-name:
Set Up/Decorate-name: Kitchen Coordinator-name: Kitchen Help-name: Games Coordinator-name: Games Help-name: Ticket Sales-name: Trunk or Treat Car-name: Clean Up Coordinator-name: Clean Up-name:
St. John the Evangelist School Registration 1/2014 1/2014
Family Work Service Hour Opportunities FAMILY NAME:
PHONE: E-MAIL:
General Room Parent, grade________-
name: Playground Supervision Help-name:
Jog-A-Thon Help-name: Fall Photo Day Help-name: Retake Photo Day Help-name: Yearbook Help-name: Art Docent Help-name: Scrip Program Help-name:
Indicate any maintenance or trade skills: (painting, electrical, plumbing, carpentry, repair, sprinklers, etc.) List any special talents or “connections” you have that you wish to share with the SJE community: (play a musical instrument, calligraphy, printing services, video production, etc.)
St. John the Evangelist School Registration 1/2014 1/2014
Craft Fair Work Service Hour Opportunities FAMILY NAME:
PHONE: E-MAIL:
Each family is required to complete a minimum of 40 hours of service. This includes 7 service hours related to the Craft Fair. No transferring hours to another family. Two mandatory hours (2 hours) must be filled in the mandatory category. Five additional hours (5 hour) can be satisfied in an area of your choosing.
Mandatory Craft Fair Help Have Truck or Flatbed to Be Used at
Set-Up/Clean-Up-name:
Set-Up Chairperson (Thurs. Eve.)-name:
Set-Up Help (Wed. Eve.)-name: Set-Up Help (Thurs. Day/ Thurs.
Eve) circle time-name: Set-Up Help (Friday a.m.)-name: Clean-Up Chairperson-name:
Clean-Up Help (Sunday)-name: Clean Grounds Before Craft Fair
Opens (Sat. /Sun.) Sweep/Vacuum and Empty Trash in
Rooms before Craft Fair Opens (Sat. /Sun.)-name:
Parking (Fri./Sat./Sun)-name: Ticket Collector Friday-name: General Greeter Sat./Sun.-name: Bussing of Dining Areas Fri.-name:
Bussing of Dining Areas Sat.-name: Bussing of Dining Areas Sun.-name:
Solicitation of Silent Auction items (before Craft Fair)-name:
Pick-Up Help for Silent Auction Items (week after Craft Fair)-name:
St. John the Evangelist School Registration 1/2014 1/2014
Silent Auction Obligation—Donate, make, purchase, or solicit new merchandise or service with a minimum value of $40 or a $40 cash donation. All items are due in the school office no later than October 1. Families not fulfilling their Silent Auction obligation by October 1 will be required to pay an additional $25 late fee. If two or more families wish to donate a service or item for a higher value, they may do so. Special considerations may be given for donations of a service or item of a higher value, such as group dinners, vacation homes, etc. Letters of introduction for soliciting items are available in the school office. Silent Auction Soliciting Soliciting Co-Chair-name: Soliciting Committee (double hours)-name:
Take Down/Clean Up Silent Auction Chair-name: Take Down/Clean Up Silent Auction on Sunday (Double Hours)-name:
Week after Auction Post Auction Chairperson-name:
Post Auction Help for Item Pick-Up-name: Follow-Up Phone Calls-name:
St. John the Evangelist School Registration 1/2014 1/2014
2014-2015 School Directory Information The SJE directory is a service to our families. Your first directory is free. Additional directories are great to keep in your car or at your office. Please indicate how many additional directories you would like to have and include payment. Make check payable to St. John’s School. _____additional directories at $5.00 each. Total enclosed_______ Children’s names and grades in 2014-2015: __________________________________ ___________
If only one parent’s name is listed, only that one name will be printed.
St. John the Evangelist School Registration 1/2014 1/2014
ST. JOHN THE EVANGELIST SHOOL VOLUNTEER DRIVER INFORMATION
You must have completed the Shield the Vulnerable online training, have fingerprint clearance and the minimum insurance requirements shown below, or you may not drive any private vehicle in connection with transporting St. John the Evangelist School students for any school sponsored activities. Before activity date, you must have a photocopy of your driver license on file in the school office and provide proof of current insurance showing limit amounts.
Name (Print):
Driver License No. and State:
Name (Print): Driver License No. and State:
Residence/Address:
Expiration Date of Driver License:
Vehicle Make, Model and Year: 1.
Vehicle License No: State:
2.
3.
I hereby certify that insurance policy number _______________________ issued by ________________________________________________________________________(Name of Insurer/Insurance Company) is in force. This policy provides liability insurance coverage on the above listed automobile(s) in amounts no less than $100,000 individual/$300,000 cumulative each loss or occurrence bodily injury, $50,000 property damage, $5,000 per person medical, and $100,000 uninsured motorist insurance. I further certify that the vehicle to be used is adequate for the use to which it is put, is equipped with seat belts, and is in safe mechanical condition. I certify that I am over 21 years of age and I have the required fingerprint clearance and Shield the Vulnerable certificate. If the above insurance is terminated, or if my driver’s license is suspended or revoked, I will immediately cease using the above owned automobile for transporting St. John the Evangelist School students for school sponsored activities and events. I certify I have read, understand, and agree to abide by the terms stated above.
St. John the Evangelist School Registration 1/2014 1/2014
St. John the Evangelist Catholic School 5701 Locust Avenue Carmichael, California 95608 (916) 481-8845 ext. 216 www.stjohnev.com Dear Parent/Guardian: The US congress passed the No Child Left Behind Act of 2001 (NCLB), which took effect January 8, 2002. Title I, Part A, of the NCLB provides supplemental educational services for eligible public and private school students. The purpose of the Act is to provide additional help for children so that they can acquire the knowledge and skills necessary to meet the challenging student performance standards that all children are expected to meet. Please take the time to complete the enclosed Family Survey. This information is very important. It will help us continue our participation in Title I educational programs, such as reading and math programs that help our students. All you need to do is mark YES or NO after each question. Your answer will be strictly CONFIDENTIAL. Remember that this information is CONFIDENTIAL. I will be the only one to read it, and will share only the data portion with the public school district liaison. If you have any questions please call me at the school office at (916) 481-8845 x216. Thank you for all that you do for our children and our school. Sincerely, ________________________________ Tosha Tillotson Principal
St. John the Evangelist School Registration 1/2014 1/2014
Non-Public Schools (NPS) Title I Family Survey
2014-15 Please provide the following information. Only your principal and the NPS Title I Coordinator will see your responses, and will keep all data strictly confidential. Parent/Guardian and Address Information
Public School District in which you live (Twin Rivers, San Juan, etc.)_________________
Neighborhood public school your student(s) would attend (if known)_________________ Student Information Only list students attending THIS private school.
Name of This Private School:__________________________________________
Student Name #1 _________________________ Grade in 14/15 _____
Student Name #2 _________________________ Grade in 14/15 _____
Student Name #3 _________________________ Grade in 14/15 _____ Family and Income Information Find your family size (all adults and children in the home) on the chart. Then, compare your gross income to the figures in the corresponding row.
Family Size Weekly Monthly Yearly
1 $409 $1,772 $21,257
2 $552 $2,392 $28,694
3 $695 $3,011 $36,131
4 $838 $3,631 $42,568
5 $981 $4,251 $51,005
6 $1,124 $4,871 $58,442
7 $1,267 $5,490 $65,879
8 $1,410 $6,110 $73,316
Each additional member, add: $144 $620 $7,437
Is your income (for your family’s size) less than the amount on the chart? ___ yes ___ no
Does your family receive assistance under Cal Works? ___ yes ___ no
Are any of your children eligible for Medicaid? ___ yes ___ no
Does your family participate in the food stamp program? ___ yes ___ no
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