Accredited by Advanced North Central Association

St. Mary’s School

Accredited by AdvancED North Central Association

12 Sixth Street Waterford, New York 12188 smswaterford.org

Phone: (518) 237-0652 | Fax: (518) 233-0898 email:

Application Form 2018-2019

Date of Application(drop-down menu)Click or tap to enter a date.

$200.00 non-refundable fee per family is due with this applicationCheck #click to enter

Please Choose Grade (dropdown menu)Choose an item.

(Please fill out page 1 for each child in the family attending St. Mary’s School)

Student Information

New Student☐ Returning☐ Date of Birth Click to enter a date. Gender Choose an item.

Last NameClick here to enter text. First Name Click here to enter Middle Name Click to enter

Street Address Click or tap here to enter text. Apt Click or tap here to enter text.

City Click here to enter text. State Zip - Phone Click to enter text.

Public School District Click or tap here to enter text.

List all school(s) previously attended, including Preschool through current year.

Grade(s)Choose an item. Name of School(s) click here to enter me of School

Does this child have an IEP or 504 plan?☐Yes (Most current must be provided, new students only)☐No

Has your child been evaluated for any behavioral/social/emotional difficulties?☐Yes ☐No

Ethnicity:☐American Indian or Alaska Native ☐Asian ☐Black or African American ☐Hispanic ☐Multiracial ☐Native Hawaiian or other Pacific Islander ☐White

Citizenship:☐US Citizen☐Non-US Citizen

Are there court orders pertaining to this child we need to be aware of? ☐Yes (please provide most current) ☐No

If not already on file, we need a copy of your child’s birth certificate, and if your child was baptized, a Baptismal certificate with this application.

Record of Sacraments

ReligionClick here.Current ParishClick here to enter text. City/StateClick here to enter .

Baptism DateClick here t ParishClick here to enter City/StateClick here to enter.

First Reconciliation DateClick hereParishClick here to enter City/StateClick here to enter

First Eucharist DateClick hereParishClick here to enter City/StateClick here to enter.

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Parent/Guardian InformationRelationship to childClick here to enter text.

Last NameClick here to enter text.First NameClick here to enter ReligionClick here to enter t

Student lives with this parent:☐Yes☐No☐Joint Custody

AddressClick here to enter text.CityClick here to enter text.StateSTZip CodeClick here

(If different from student)

EmailClick here to enter text. Home PhoneClick here to enterCell PhoneClick here to enter

(For school notifications)

OccupationClick here to enter text.EmployerClick here to enter Work PhoneClick here

Parent/Guardian InformationRelationship to childClick here to enter text.

Last NameClick here to enter nameFirst NameClick here to enter ReligionClick here to enter

Student lives with this parent:☐Yes☐No ☐Joint Custody

AddressClick here to enter text.CityClick here to enter text.StateSTZip CodeClick here

(If different from student)

EmailClick here to enter text. Home PhoneClick here to enterCell PhoneClick here to enter

(For school notifications)

OccupationClick here to enterEmployerClick here to enterWork PhoneClick here to enter

Please list other children not attending St. Mary’s School and the school they do attend if applicable:

NameSchool Click here to enter text.

My digital signature below indicates I understand my child’s records must be received and reviewed, and other admittance

requirements met before official acceptance. I have read the policies of St. Mary’s School, including but not limited to,

the tuition policy, and agree to allconditions as published in the student parent handbook found on the school website.I

agree that the electronic signature I am affixing to this application is evidence of my desire to enter into a contract with St.

Mary’s School and shall be as valid as an original signature.

Parent SignatureClick here to enter digital signature

DateClick here to enter a date.

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