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Academy Registration Form -

- Ministries
  - The Three Hearts Academy
    
    MISSION
    WHY TOGETHER? TO RAISE SAINTS!
    PROGRAM: 2021-2022
    REGISTRATION
    
    NEWS
    CONTACT US
  - Knights of Columbus

* Please complete by ***extended*** Friday, August 6, 2021!
* Registrations will be accepted after this date; commitments and numbers are needed soon to plan classes, grade levels and schedules
The maximum number of form submissions has been reached. This form is currently not available.
- FAMILY NAME REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- 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.
- Registered at St. Catherine's Parish? REQUIRED Please fill out this field.
- Parent/Guardian (#1) REQUIRED
  First Last name (and Religion on line below)
  Please fill out this field.
- Phone Number #1 REQUIRED Please fill out this field. Please enter a phone number.
- Preferred Email REQUIRED Please fill out this field. Please enter an email address.
- Parent/Guardian (#2) REQUIRED
  First Last name (and Religion on line below)
  Please fill out this field.
- Phone Number #2 REQUIRED Please fill out this field. Please enter a phone number.
- Second Email Please enter an email address.
- Emergency Contact REQUIRED
  (if guardian is unavailable) Name (first, last); Relationship; Address; Phone number
  Please fill out this field.
- Current Homeschooling Family? REQUIRED Please fill out this field.
- CHILDREN ENROLLING REQUIRED Please fill out this field.
  
  Child 1
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 2
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 3
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 4
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 5
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 6
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
  
  Child 7
  
  Name Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Upcoming Grade (in '21-'22) REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Learning Abilities/Challenges?
  
  Health Concerns/Allergies? REQUIRED
  List any medical or health issues, including allergies
  Please fill out this field.
- NURSERY CHILDREN REQUIRED Please fill out this field.
  
  Child 1
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Health Concerns/Allergies?
  List any medical or health issues, including allergies
  
  Child 2
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Health Concerns/Allergies?
  List any medical or health issues, including allergies
  
  Child 3
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Gender REQUIRED Please fill out this field.
  
  Health Concerns/Allergies?
  List any medical or health issues, including allergies
- VOLUNTEERING/HELP:
- Other Information?
  Please type any other information you think is important.
- Tuition Payment Preference REQUIRED
  Tuition begins to be due: Friday, August 6, 2021.
  Please fill out this field.
- Auto Reply Email (if desired) Please enter an email address.
- Today's Date REQUIRED Please fill out this field. Please enter a date.
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