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Private School Confirmation Registration

Please complete the form below. Required fields marked with an asterisk *
State*
Answer Required
Is your family registered in the parish?*
Answer Required
Is the child new to St. Clement of Rome?*
Answer Required
Is the child new to St. Clement of Rome?*
Answer Required

NEW STUDENTS - PLEASE PRESENT A COPY OF STUDENT BAPSTIMAL CERTIFICATE WITH REGISTRATION.

 

Tuition - $50.00 per child

Emergency Information

In case of serious accident or serious illness, I request the school contact me. By clicking YES below, I hereby authorize the school to call the physician indicated below and follow his instructions. If it is impossible to contact the physician, the school may make the appropriate arrangements for the care of my child.*
Answer Required

Physician's Information

State*
Answer Required

Name two neighbors or relatives who will assume temporary care of your child if you cannot be reached.

State*
Answer Required
State*
Answer Required
Do any of your children receive any Special Services at their school or after hours?*
Answer Required
Do any of your children have special medical needs or are on any medications?*
Answer Required