Registration Form

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Father Last Name (if different) Please enter valid data.

Father First Name Please enter valid data.

Father Cell Phone Please enter a phone number.

Father Employer Please enter valid data.

Father Work Phone Please enter a phone number.

Mother Last Name (if different) Please enter valid data.

Mother First Name Please enter valid data.

Mother Cell Phone Please enter a phone number.

Mother Employer Please enter valid data.

Mother Work Phone Please enter a phone number.

Home Address REQUIRED Please fill out this field.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mailing Address (if different)

Additional Home Address (if applicable)

Email REQUIRED Please fill out this field. Please enter an email address.

Additional Email Please enter an email address.

Home Phone Number Please enter a phone number.

Emergency Contact(s) REQUIRED Please fill out this field.
Emergency Contact 1
- Emergency Contact First and Last Name Please enter valid data.
- Emergency Contact Phone Number Please enter a phone number.
Emergency Contact 2
- Emergency Contact First and Last Name Please enter valid data.
- Emergency Contact Phone Number Please enter a phone number.
Emergency Contact 3
- Emergency Contact First and Last Name Please enter valid data.
- Emergency Contact Phone Number Please enter a phone number.
Emergency Contact 4
- Emergency Contact First and Last Name Please enter valid data.
- Emergency Contact Phone Number Please enter a phone number.

Number of Children REQUIRED Please fill out this field.
Children 1
- Child First Name Please enter valid data.
- Child Last Name (if different) Please enter valid data.
- Date of Birth Please enter a date.
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender Female Male
- Grade in the Fall Pre K Full Time (5 Day) Pre K (3 Day) M,W,F Pre K (2 Day) T & Th Kindergarten Grades 1-6 (1 child) Grades 1-6 (2 children) Grades 1-6 (3 children) Grades 1-6 (4 children)
- District of Residence Please enter valid data.
- Does child have an IEP REQUIRED Yes No Please fill out this field.
- If child has an IEP, in which school district? Please enter valid data.
- Ethnicity Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
- Student's Religion Please enter valid data.
- Has this student received the Sacrament of Baptism? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- If baptized, please list church, location and date
- Has this student had their First Reconciliation? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Reconciliation
- Has this student received their First Holy Communion? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Communion
- Home Parish and location
- Allergies? Yes, please list in next box No
- Allergies
Children 2
- Child First Name Please enter valid data.
- Child Last Name (if different) Please enter valid data.
- Date of Birth Please enter a date.
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender Female Male
- Grade in the Fall Pre K Full Time (5 Day) Pre K (3 Day) M,W,F Pre K (2 Day) T & Th Kindergarten Grades 1-6 (1 child) Grades 1-6 (2 children) Grades 1-6 (3 children) Grades 1-6 (4 children)
- District of Residence Please enter valid data.
- Does child have an IEP REQUIRED Yes No Please fill out this field.
- If child has an IEP, in which school district? Please enter valid data.
- Ethnicity Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
- Student's Religion Please enter valid data.
- Has this student received the Sacrament of Baptism? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- If baptized, please list church, location and date
- Has this student had their First Reconciliation? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Reconciliation
- Has this student received their First Holy Communion? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Communion
- Home Parish and location
- Allergies? Yes, please list in next box No
- Allergies
Children 3
- Child First Name Please enter valid data.
- Child Last Name (if different) Please enter valid data.
- Date of Birth Please enter a date.
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender Female Male
- Grade in the Fall Pre K Full Time (5 Day) Pre K (3 Day) M,W,F Pre K (2 Day) T & Th Kindergarten Grades 1-6 (1 child) Grades 1-6 (2 children) Grades 1-6 (3 children) Grades 1-6 (4 children)
- District of Residence Please enter valid data.
- Does child have an IEP REQUIRED Yes No Please fill out this field.
- If child has an IEP, in which school district? Please enter valid data.
- Ethnicity Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
- Student's Religion Please enter valid data.
- Has this student received the Sacrament of Baptism? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- If baptized, please list church, location and date
- Has this student had their First Reconciliation? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Reconciliation
- Has this student received their First Holy Communion? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Communion
- Home Parish and location
- Allergies? Yes, please list in next box No
- Allergies
Children 4
- Child First Name Please enter valid data.
- Child Last Name (if different) Please enter valid data.
- Date of Birth Please enter a date.
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender Female Male
- Grade in the Fall Pre K Full Time (5 Day) Pre K (3 Day) M,W,F Pre K (2 Day) T & Th Kindergarten Grades 1-6 (1 child) Grades 1-6 (2 children) Grades 1-6 (3 children) Grades 1-6 (4 children)
- District of Residence Please enter valid data.
- Does child have an IEP REQUIRED Yes No Please fill out this field.
- If child has an IEP, in which school district? Please enter valid data.
- Ethnicity Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
- Student's Religion Please enter valid data.
- Has this student received the Sacrament of Baptism? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- If baptized, please list church, location and date
- Has this student had their First Reconciliation? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Reconciliation
- Has this student received their First Holy Communion? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Communion
- Home Parish and location
- Allergies? Yes, please list in next box No
- Allergies
Children 5
- Child First Name Please enter valid data.
- Child Last Name (if different) Please enter valid data.
- Date of Birth Please enter a date.
- Country of Birth REQUIRED Please fill out this field. Please enter valid data.
- Gender Female Male
- Grade in the Fall Pre K Full Time (5 Day) Pre K (3 Day) M,W,F Pre K (2 Day) T & Th Kindergarten Grades 1-6 (1 child) Grades 1-6 (2 children) Grades 1-6 (3 children) Grades 1-6 (4 children)
- District of Residence Please enter valid data.
- Does child have an IEP REQUIRED Yes No Please fill out this field.
- If child has an IEP, in which school district? Please enter valid data.
- Ethnicity Hispanic or Latino American Indian or Alaska Native Asian Black or African American Native Hawaiian or other Pacific Islander White
- Student's Religion Please enter valid data.
- Has this student received the Sacrament of Baptism? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- If baptized, please list church, location and date
- Has this student had their First Reconciliation? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Reconciliation
- Has this student received their First Holy Communion? Yes, please list details in next box No No, but I would like to discuss this and learn more.
- First Communion
- Home Parish and location
- Allergies? Yes, please list in next box No
- Allergies

Please provide a copy of your child(ren) birth certificate. Copies can be brought in to the office, mailed to the school or emailed to: school@stambroselatham.com. Thank you.

Non-refundable Registration Fee REQUIRED

$175 will be applied to a tuition payment.

250 – Individual

325 – Family Please fill out this field.

By checking below I, the above named person, agree that I will remit tuition payments as follows (please choose one option): Payment will be made in full no later than August 1, 2019 through FACTS. Ten payments to be made through FACTS beginning August 2019.

I am applying for financial aid in the amount listed below. I understand that I will be notified if I am eligible in June. Until notified, I understand that I am responsible for the full tuition amount. REQUIRED Yes, I am applying and I understand. No, I am not applying for financial assistance. Please fill out this field.

It is the tuition policy of the Albany Diocesan School Board to prohibit a student from entering class on the opening day of school if tuition payments are not current in accordance with the enrollment contract.

By checking the box below, I am responsible for all payments of all tuition and any after-school charges. This agreement is made between St. Ambrose School and me, the undersigned parent, guardian or another party responsible for the payment of all tuition charges.

I Agree Please select this field.

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