Registration Form

St. Matthew’s Lutheran School
621 S.W. 22^nd Avenue Road, Miami, Florida 33135
Telephone: 305-642-4177 Fax: 305-642-3477

Registration Folder
For school Year 201 - 201

Student’s Name:
First Middle Last
Grade Entering:

For Office Use Only

     The following checked items must be submitted with the application:
     Birth Certificate
     Copy of Social Security Card/Number
     Up-to Date Immunization Record
     Health Physical
     Copy of Previous Report Card
     Last School Quarter Evaluation
     Copy of Last SAT or FCAT Scores
     Letters of Recommendation From:: 1. 2.

     Paid Registration Fee* of: Pre-K: $          Kindergarten: $
                                     Elementary Grades: $          Middle Grades: $
     Book/Material Fee of: $         $         $         $
     Signed Application and Financial Agreement    (*) Registration Fees are non-refundable

Registration Form
School Year 201 - 201
A separate application must be completed for each child. Application must be completely filled out and signed.

Student’s Information:
Enrollment (today’s) Date: Grade Entering:
Student’s Full Legal Name:
Social Security No. - - Citizenship:
Address where student Reside:
Student Resides with: Both Parents Mother Father Legal Guardian
Last School Attended: City:

Parent’s Information:
Father: Mother:
Home Telephone Number:
Address if different from student’s:
Parents are: Married Separated Divorced Living together Spouse Diseased
Name of person responsible for tuition:

Father’s Information:
Name: Social Security No. - -
Complete Address: City : Zip Code:
Employer: Address:
Position: Telephone Number:
Cellular #. Pager: Other:
Race/Ethnic: White Black Asian Native American Hispanic

Mother’s Information:
Name: Social Security No. - -
Complete Address: City: Zip Code:
Employer: Address:
Position: Telephone Number:
Cellular # Pager: Other:
Race/Ethnic: White Black Asian Native American Hispanic

Guardian’s Information (if applicable)
Name: Relationship to Child:
Address: City: Zip Code:
Employer: Telephone Number:
Home Telephone No. Cell #
Church Affiliation:

Emergency Contacts:
1. Mane: Relationship:
Home # Work # Cell #
2. Name: Relationship:
Home # Work # Cell #
3. Name: Relationship:
Home # Work # Cell #
Do the above listed know they are listed as EMERGENCY CONTACTS? Yes No

Individuals Authorized to Pick Up My Child:
Check all that apply: Mother Father Others Listed Below
Name: Relationship:
Name: Relationship:
Name: Relationship:
Name: Relationship:
Name: Relationship:

Child’s Medical Information:
Child’s Doctor: Telephone #
In case of an emergency, if parents cannot be reached, do you authorize contacting your child’s doctor’s office?
Yes No
In case of an emergency and the parents or child’s doctor’s office cannot be reached, do
You authorize contacting the 911 emergency number? Yes No

In case of an emergency, what is your Hospital of Choice?
Please list any allergies:
Please list any other helpful information such as Educational or Behavioral Testing; any
Diagnosis, fears, etc.

Family Church Information:
Family church affiliation: Roman Catholic Lutheran Baptist Pentecostal
Presbyterian Methodist Other:
Is the family active in a congregation? Yes No
My child is baptized already: Yes No If yes, in what parish?

Please Note: Before a student is officially admitted, this form must be completed and all required documents are submitted, this includes: Health/physical records, Immunizations, Birth Certificate, copy of social security card, visa (if applicable), SAT/FCAT scores, last Report Card, recommendations (if needed) and signed financial contract. Any missing information must be provided within 30 days after enrollment.
By signing here, I agree that the information contained herein is true and accurate. I also agree to inform the school office immediately when information concerning my student changes.

Parent/Guardian Signature: _____________________________ Date:

St. Matthew’s Lutheran School
Statement of Payment Policies

St. Matthew’s Lutheran School offers academic and childcare programs for registered students only from age 3 through Eighth Grade. The following tuition and fee policies apply to these hours:
                                                                                     Before School Care: 7:30A.M. to 8:30A.M.
                                                                                     School Day Hours: 8:30A.M to 3:15P.M.
                                                                                     After School Program: 3:15P.M. to 6:00P.M.

The monthly fees and tuition are due and payable at the 20^th day of each month, beginning on August 20. The last tuition payment is due not later than May 20.

An account is deemed “late” when payment is received after the 29^th of the month. A late fee of $25.00 will be assessed to your account if payment is received after the 29^th of the month.

A $50.00 fee will be charged for checks returned for non-sufficient fund. Payment and fee for returned checks must be paid to St. Matthew’s in cash, cashier’s check, or money orders to St. Matthew’s within 7 business days of notification.

A 30 days “Notice of Withdrawal” from any program is required in writing to the school office.

Report Cards and any school documents or recommendations will be held until accounts are up- to-date or paid in full. The registration fee covers student’s insurance, SAT exams and materials other than text books, and will not be returned if your child is enrolled in class for 10 days of classes, expelled or withdrawn from St. Matthew’s without proper notice.

Tuition Schedule:
GRADE YEARLY MONTHLY REGISTRATION* BOOK/MATERIAL FEE

Pre-Kinder:	$	$	$	$
Kindergarten:	$	$	$	$
Grades 1-5	$	$	$	$
Grades 6-8	$	$	$	$	(*) Registration fees are non-refundable

The discount for a second child is 15% The discount for the third and additional children is 25%

St. Matthew’s is approved by the State of Florida Department of Education for state scholarship programs. It is the parent’s responsibility to apply for any state program. Payment of tuition and fees remains the responsibility of the parent/guardian.

Tuition and fees are based on a full-time registered and enrolled student. The tuition is charged on a monthly basis. If a student is absent for any portion of the academic days of the month, the account is still responsible for the entire monthly charge. Our tuition is based on the entire school year and it may be broken down into monthly payments, not to exceed 10. Services for academic and child care programs may be suspended or revoked for past-due accounts.

If you are having difficulty paying your account promptly, please contact the school office to make arrangement suitable for both you and St. Matthew’s. Accounts must be up-to-date in order to register for the next school year. The cost of operating a school is dependent on timely payments of tuition and fees. Please direct all payments and questions concerning your account to the school office.

By signing this folder, you agree to the above stated tuition, fee schedule, and policies, and make prompt payments in accordance to the above, or promptly resolve any difficulties with the appointed agent of St. Matthew’s Lutheran school.

Signature: ___________________________________________ Today’s Date: Home page
Relationship to Child: Please fill in the blanks & print - Sign in the presence of school administrator