Saint Mary Academy: Online Application

Ready To Enroll?

Order of Priority in Admission

At the time of pre-registration in January, Saint Mary Academy will use the following order of priority for admission to the school. Once a grade level is full, all remaining pre-registered students will be placed on a waiting list and will be admitted as openings become available. The order of priority in admission is as follows:

1. Children currently enrolled at Saint Mary Academy (Preschool – Grade Eight) and their siblings;
2. Catholic families who are members of Saint Bernadette parish
3. Catholic families who are members of any other Catholic parish
4. Families who are not Catholic or not members of a parish

Saint Mary Academy does not discriminate on the basis of race, creed, sex, color, or national origin in the admission of its pupils.

Thank you for your interest in your child attending Saint Mary Academy. As Catholic school educators, we are very aware of our roles and responsibilities as we partner with you to grow disciples of Christ. In order to be considered for admission, the following documents are required:

• Student Application Form (Online)
• Student Information Form (Online)
• Request and Release of Records (grades 1-8) (Online)
• Disclosure and Acceptance Agreement (Online)
• Archdiocese of Louisville Agreement
• Birth Certificate (issued by a government entity; not from the hospital)
• Baptismal Certificate (if applicable)
• Current Immunization Certificate
• Copies of current report cards and standardized test scores (grades 1 - 8)
• Strategy or Accommodation Plan (if applicable)
• $500 deposit per new family; $100 deposit per current family

Please note that submission of online documents does not guarantee admission to Saint Mary Academy. Once all documents have been received, you will be contacted by our admissions coordinator to review the next steps in the application process. All required documents not found online and the deposit should be mailed to:

Saint Mary Academy
Attn: Mrs. Kristine Simon, Admissions Coordinator
11311 Saint Mary Lane
Prospect, KY. 40059

Download Archdiocese Agreement Download Disclosure and Acceptance Form

Online Application

Preschool-8th
Application
Records
Release
Bus
Application
After-School
Application
Archdiocese
Agreement
Disclosure and
Acceptance Form

ARCHDIOCESE OF LOUISVILLE CATHOLIC ELEMENTARY SCHOOLS STUDENT APPLICATION FORM

Parent/Guardian #1 Parent/Guardian #2
Name* Name*
Relationship* (Mother, Father, Step-parent, Guardian, Grandparent, Deceased) Relationship* (Mother, Father, Step-parent, Guardian, Grandparent, Deceased)
Marital Status* (Married, Single, Widowed, Divorced, Remarried, Separated) Marital Status* (Married, Single, Widowed, Divorced, Remarried, Separated)
Street Address* Street Address*
City, State Zip* City, State Zip*
Home Phone* Home Phone*
Work Phone Work Phone
Email Address* Email Address
Religion Religion
Employer Employer
Occupation Occupation

Direct Correspondence to:
Street Address
City, State Zip
County of Residence
PhonePublish in School Directory
Email* Publish in School Directory
Language(s) Spoken In Home
Names and birth dates of ALL children in family (list pre-school children first)
Boys
Girls
Custody(if applicable)SingleJointName(s)
If you and the physician of your choice, as indicated on back, cannot be reached in an emergency and, if in the judgement of the school authorities, immediate medical and/or hospital attention is indicated, do you authorize the school authorities to send your child (properly accompanied) to an available hospital or physician?
YesNoSignature*
As a parent and/or guardian, I authorize the treatment of a minor child/children by a qualified and licensed medical doctor in the event of a medical emergency which, in the opinion of the attending physician, may endanger child’s life, cause physical disability or undue
discomfort if delayed. This consent is granted only after reasonable effort has been made to reach me.
YesNoSignature*

Student Information

Name* Proposed Grade Placement
Date-of-Birth* Birth City/State/County
Sex*MaleFemale Oldest Child?YesNo
First Language Child Learned to Speak Language Child Speaks Most Often
Current Parish*
For Pre-School or Pre-Kindergarten students:
Preschool (3-4 year old)Half DayFull Day
(students must be 3 by 8/1 and fully toilet trained)Pre-Kindergarten PK (4-5 year old)Half DayFull Day
(students must be 4 by 8/1 and fully toilet trained)
After School, child goes to:
Place* Phone*
Contact*

Religious Records

Sacrament	Date	Church	City, State Zip
Baptism
First Eucharist
First Reconciliation
Confirmation

Health/Emergency Information

First Contact
Name* Relation*
Phone*
Second Contact
Name* Relation*
Phone*
Doctor
Name* Address
Phone*Preferred Hospital*
Health/Physical Limitations
Medication(s)
Instructions/Allergies
Immunization Expiration Date
Transferred Information
School Entered
Address Withdrew
Reason Code1 - Completed Program2 - Moved3 - Illness4 - Parent Choice5 - Other
Signature*

Request and Release Form for Records

Request for records of students transferring from another school

Dear Principal:

Please send copies of school records, standardized test scores, and health data to Saint Mary Academy for the following student(s). Written permission to release these records has been given, as indicated below.

Bus Application

Saint Mary Academy contracts with Miller Transportation to provide safe, reliable and cost-effective bus transportation for our students.

In order to reserve a spot for your K-8 child(ren) on the bus for your child(ren) for the 2019 – 2020 school year, please fill out the bus form below. The $50 registration fee will be pulled from your FACTS account.

1 child - $4002 children - $6003 children - $800

As you can imagine, there are a number of factors to consider when establishing routes and stops and we rely on officials at Miller Transportation to assist us with this matter. While we try our very best to accommodate as many families as possible, bus transportation is not guaranteed for everyone who requests it. Final routes and pick-up and drop-off times will be determined by Miller Transportation.

If you are interested in bus transporation for your child(ren) for next year, please complete the nexessary information below.

Family Last Name # of Children
Name of First Child Grade Next Year
Name of Second Child Grade Next Year
Name of Third Child Grade Next Year

Street Address
City, State Zip
Subdivsion
Days: MondayTuesdayWednesdayThursdayFriday
Times: MorningAfternoonBoth

After-School Care Information

$50.00 Registration fee per family

If you would like your child(ren) to participate in the After School Care program for the 19-20 school year, please complete a registration form for each child by June 1st. On June 14th, a $50 registration fee per family will be drawn from your FACTS account.

Please note, that we only offer full and part time options. The monthly rates are listed below are based on an annual fee divided into ten equal payments from August-May. After school care is available when there is an 11:30 dismissal, but not when school is not in session.

Please note that we are offering full-time and part-time options only this year. Due to State regulations regarding staffing levels for After School Care, we are no longer able to offer the drop-in option.

**If you have multiple children who will be attending after school care, you must complete a registration form for each child.

1-3 Days per week (monthly payment):

1 Child - $170.002 Children - $270.003 Children - $350.00

4-5 Days per week (monthly payment):

1 Child - $260.002 Children - $460.003 Children - $620.00

Payments must be made through our new FACTS system online. Through the FACTS system, you will be able to choose the 5th or the 20th of the month for your monthly payment, or split it into two payments, one on the 5th and one on the 20th.

Hours of operation are 2:30PM-6:00PM for both preschool and K-8. Please note, there is a $1.00 per minute charge for children that are picked up AFTER 6:00PM. The fee will be charged to you in FACTS.

At the end of the year, After School Care statements will be sent to each family. The amount paid may be an allowable deduction on your taxes.

If you have any questions regarding After School Care, please contact Shirley Anderson at (502) 315-2557.

After-School Care Registration

Child's Information

Child's Name
Date of BirthGrade
List All Allergies:
Additional Information we need to know to assist your child:
Days of the Week Attending: MondayTuesdayWednesdayThursdayFriday

Contact Information

Mother's Name
Work PhoneCell Phone
Father's Name
Work PhoneCell Phone

Alternate Emergency Contact Information

Name
RelationshipPhone
People authorized to pick up your child/children:

Pediatrician Information

NamePhone

Preferred Hospital (please select one)

Norton Kosair Children's Hospital (Downtown)Kosair Children's Medical Center Brownsboro

Archdiocese Agreement

Dear Parents,

With Jesus Christ as our foundation and parents as the primary educators of our children, we, as Catholic educators, are committed to excellence in both faith formation and academics, while meeting the needs of the whole student and respecting the diversity in our student and parish populations.

We look forward to working with you as partners in a spirit of cooperation and support in your child's academic and religious formation.

We welcome this application for admission of your child to one of the elementary schools of the Archdiocese of Louisville.

Please be aware that the following admission policies are in effect:

Age:
For first grade - a child must be 6 years of age by August 1 of 2019
For kindergarten - a child must be 5 years of age by August 1 of 2019
For 4 year old prekindergarten - a child must be 4 years of age by August 1 of 2019
For 3 year old preschool - a child must be 3 years of age by August 1 of 2019

Records:
All new students must present previous records from all schools attended as well as immunization health records, birth certificates and records of sacraments (if applicable).

Your signature below indicates your agreement to abide by the school policies of the parish and the Archdiocese of Louisville.

Leisa Schulz
Superintendent of Schools
Archdiocese of Louisville

Disclosure and Acceptance Form

Application for Admission
Request and Release of Records
Disclosure and Acceptance Agreement
Archdiocese of Louisville Agreement
Birth Certificate (issued by a government entity, not from the hospital)
Baptismal Certificate (if applicable)
Current Immunization Certificate
Copies of current report cards and standardized test scores (grades 1 -8)
Strategy or Accommodation Plan (if applicable)
Non-refundable $500 deposit per new family; $100 deposit per student for current families

SMA School officials must also be informed of any testing for Learning Differences by any public or private school system or any private agency. Copies of testing reports are required to be considered for acceptance. Saint Mary Academy has the right and obligation to decide if its program will best meet an individual child's learning needs. We also ask that the Parent/Guardians inform Saint Mary Academy officials of their child's special academic, emotional, or physical needs.

Students who are admitted to Saint Mary Academy will be accepted on a probationary basis for a period of one year. Regular assessments will determine if the student is making satisfactory academic, behavioral and social adjustment.

Mrs. Lisa Kelly
Principal

We, the family, have read and understand the above. We understand that admission is conditional upon providing the required documents and acceptance is not implied.

Signed:
Date:

Saint Mary Admissions